Frozen shoulder, medically known as adhesive capsulitis, is a condition characterized by pain, stiffness, and limited mobility in the shoulder joint. It can present in a variety of ways with regards to severity of pain and functional limitations. If you have had this or currently have this, I sympathize with you as I had this a couple of years ago and I experienced excruciating pain at times and it lasted much longer than I anticipated. But, with time, treatment, exercises and patience, you will recover. 

In this blog, I will discuss an overview of frozen shoulder, its causes, diagnosis, and treatment. And, also explore the connection between frozen shoulder and menopause, highlighting the impact of hormonal fluctuations and discussing management strategies for women going through this phase of life. 

THE CAUSES OF FROZEN SHOULDER

The exact cause of frozen shoulder remains unclear. However, certain factors may increase the risk of developing this condition. 

•  Age and Gender: Individuals aged 40 to 60, predominantly women, are more susceptible to frozen shoulder. Hormonal changes during menopause have been identified as a potential contributing factor. 

• Medical Conditions: Certain medical conditions such as diabetes, thyroid disorders, cardiovascular diseases, and Parkinson's disease are associated with an increased risk.

•  Immobilization: Prolonged immobilization of the shoulder joint due to injury, surgery, or a sedentary lifestyle can contribute to the development of frozen shoulder.

THE SYMPTOMS OF A FROZEN SHOULDER

The hallmark symptoms of frozen shoulder often develop gradually and can be divided into three stages.

1. Freezing Stage: The shoulder experiences increasing pain and stiffness. Range of motion becomes limited, making simple tasks challenging.

2. Frozen Stage: Pain is often still present but may start to diminish, but stiffness and restricted movement persist. Daily activities like combing hair or reaching for objects become difficult.

3. Thawing Stage: The range of motion slowly improves, and pain subsides. Recovery can take several months to years.

HOW FROZEN SHOULDER IS DIAGNOSED

To diagnose a frozen shoulder, a Physical Therapist or Medical Doctor will evaluate your medical history, conduct a physical examination, and may order imaging tests such as X-rays or magnetic resonance imaging (MRI) to rule out other underlying conditions.

HORMONAL INFLUENCE OF FROZEN SHOULDER:

During menopause, women experience a decline in estrogen levels, which can have several effects on the body. Estrogen plays a crucial role in maintaining joint health by promoting the production of synovial fluid, which lubricates the joints and reduces friction. The reduction in estrogen levels during menopause can lead to a decrease in synovial fluid production, resulting in joint stiffness and increased risk of conditions like frozen shoulder.

Increased Risk and Symptomatology:

Women going through menopause may be at a higher risk of developing frozen shoulder compared to those in other life stages. The hormonal changes associated with menopause can contribute to the development of this condition. Additionally, the symptoms of frozen shoulder can be more pronounced and prolonged in menopausal women, making daily activities and shoulder movements even more challenging.

TREATMENT OPTIONS FOR FROZEN SHOULDER

TREATMENT OPTIONS: The treatment for frozen shoulder aims to alleviate pain, restore range of motion, and improve functionality. The following approaches are commonly used:

1. Physical Therapy and Exercise: Physical therapy exercises tailored for frozen shoulder can help improve range of motion and reduce stiffness. Regular stretching and strengthening exercises can promote shoulder flexibility and joint stability. Women going through menopause can benefit from incorporating targeted shoulder exercises into their routine to prevent or manage frozen shoulder. Dry needling and cupping may help as well. This is the first course of treatment that I recommend and is often the only one needed. 

   • *Keep reading to learn specific exercises to perform for treatment.*

2. Pain Management: Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) or prescribed pain medications can be used to manage pain and inflammation associated with frozen shoulder. These medications can help provide temporary relief and allow you to engage in physical therapy exercises more comfortably. Injecting corticosteroids into the shoulder joint can also provide temporary relief from pain and inflammation. If pain is unbearable, an injection can make a big difference to allow you to perform PT exercises and perform activities of daily living with less pain. 

3. Heat and Cold Therapy: Applying heat packs or using warm water soaks can help relax the shoulder muscles and improve blood flow, reducing pain and stiffness. Cold therapy, such as ice packs, can be beneficial for reducing inflammation and swelling. Do whichever one feels better and provides relief. Some benefit from alternating between the ice and heat. 

4. Surgery: If other treatments fail to improve symptoms, surgical intervention such as manipulation under anesthesia or arthroscopic release may be considered to release the tight tissues and restore shoulder mobility. But, this procedure is hardly ever necessary and I don’t recommend it since it increases inflammation and pain. 

5. Lifestyle Modifications: Maintaining a healthy lifestyle, including regular exercise, a balanced diet, and adequate rest, can contribute to overall joint health. Additionally, avoiding repetitive or excessive shoulder movements, maintaining good posture, and using proper body mechanics during daily activities can help prevent exacerbation of frozen shoulder symptoms. Engaging in low-impact exercises or activities that promote gentle movement without putting excessive stress on the shoulder. Walking is great and focus on allowing your arms to swing naturally.

6. Hormone Replacement Therapy (HRT): Hormone replacement therapy involves taking medications that contain hormones, such as estrogen and progesterone, to alleviate menopausal symptoms. While HRT can potentially improve joint health and reduce the risk of frozen shoulder, its use should be carefully discussed with a healthcare professional, considering individual factors and potential risks.

   
   

PHYSICAL THERAPY EXERCISES FOR FROZEN SHOULDER

Exercise can play a crucial role in managing frozen shoulder by improving flexibility, reducing stiffness, and gradually restoring range of motion. It's important to note that before starting any exercise program, it's recommended to consult with a healthcare professional or physical therapist who can provide guidance tailored to your specific condition. By incorporating a variety of exercises targeting different aspects of shoulder mobility, you can effectively manage frozen shoulder and improve your overall range of motion and function. 

Below are some of the exercises I recommend to my patients to treat frozen shoulder:  

1. Backward Shoulder Rolls: Roll your shoulder blades up, back, down, and around. Repeat for 10 reps throughout the day. I use the exercise and the next one as a warm-up and just a feel good exercises throughout the day. 

2. Shoulder squeezes (scapular retraction): Squeeze your shoulder blades together. Hold for 3 seconds and repeat 10 times. This is a great one to go throughout the day, especially if you sit a lot or want to work on your posture. 

3. Pendulums: Stand with your unaffected arm resting on a table or chair for support. Let your affected arm hang freely. Gently swing your affected arm in small circles clockwise and counterclockwise. Perform 10 circles in each direction. This exercise helps to improve the mobility of the shoulder joint.

4. Wall walks: Flexion and Abduction. Stand facing a wall and place your fingertips on the wall at chest height. Slowly walk your fingers up the wall, reaching as high as you comfortably can. Then, walk your fingers back down. Repeat this exercise 10 times to gradually increase shoulder mobility. If possible, rotate your body away from the wall and hold the stretch. Then, slowly walk your fingers back down. Repeat this exercise 10 times to gently stretch the shoulder muscles.

5. Shoulder Extension with Wand: Hold a long wand or broomstick with both hands behind you, gripping it wider than shoulder-width apart. Keeping your elbows straight, slowly extend the wand off you back into shoulder extension. Then, if possible, bend your elbows as you slide the wand up your back. Perform 10 repetitions.

6. Doorway stretch for External Rotation: Stand in a doorway with your affected arm raised and bent at a 90-degree angle, placing your forearm and palm against the doorframe. Take a small step forward with the foot on the same side as your affected arm. Lean your body gently forward, allowing your chest to move through the doorway, while keeping your forearm and palm in contact with the doorframe. You should feel a stretch in the front of your shoulder and chest. Hold the stretch for about 15-30 seconds while maintaining a comfortable level of tension. Relax and repeat the stretch for 3-5 times, gradually increasing the stretch as tolerated.

7. Child’s pose: Sit on your heels, knees spread more than hip distance apart and bring your head towards the floor. Stretch your arms in front of you with the palms toward the floor. Breathe and relax into the pose. Try reaching your arms a bit longer out in front of you for a bigger stretch. Stay in this position for at least 30 seconds and repeat 2 times. 

Remember, it's important to start these exercises gently and gradually increase the intensity as your shoulder allows. As always, listen to your body and work within your pain-free range of motion. If you experience increased pain or discomfort, reduce the intensity of the stretch or consult with a healthcare professional or physical therapist for further guidance. Consistency and patience are key when performing these exercises to effectively manage frozen shoulder and regain full range of motion over time.

CONCLUSION:

Frozen shoulder can be a challenging and frustrating condition, but with appropriate treatment from a physical therapist and diligent self-care, most individuals experience gradual improvement in pain and range of motion. Understanding the hormonal influence and recognizing the symptoms of frozen shoulder during menopause is essential for timely intervention and management. By adopting a multidisciplinary approach that includes physical therapy, pain management strategies, and lifestyle modifications, women can effectively manage frozen shoulder symptoms, reduce discomfort, and improve their overall quality of life during this transformative stage. 

If you suspect you may have a frozen shoulder, it is important to consult a healthcare professional for an accurate diagnosis and appropriate management plan. Remember, early intervention and consistent care can greatly contribute to a smoother recovery process, enabling you to regain optimal shoulder function and resume your daily activities with ease.