Painful shoulder

Frozen shoulder syndrome is a painful and long-lasting condition

Causes of pain in the shoulder joint

Pain can occur when raising the arm above the head or when moving it forward or behind the back. The most common cause of this pain is impingement of the rotator cuff tendons, which leads to inflammation or damage of the tendons. This condition is called rotator cuff tendinitis. The bursa, through which the tendons of the muscles glide, can also become inflamed; this is called bursitis. Pain and stiffness in the shoulder can also be caused by frozen shoulder syndrome or, medically, adhesive capsulitis.

What is characteristic of frozen shoulder syndrome?

The typical signs of this condition are severe pain and a complete inability to move the shoulder, both actively and passively. The syndrome develops in three phases:

In the “freezing phase” pain gradually increases, and the shoulder becomes less and less mobile. 6 weeks to 9 months, in most cases the pain can be relieved on your own – try applying ice to the shoulder three to four times a day for 10–15 minutes. The ice or cooling pack should be wrapped in a cloth to prevent frostbite.
In the “frozen phase”, the pain may decrease, but joint stiffness remains, – especially limited are rotation of the arm and moving it away from the body. During the 4- to 6-month phase, daily activities are very limited and quality of life decreases.
In the “thawing phase”, shoulder mobility gradually improves again, and full recovery of normal mobility usually takes 6 months to 2 years.

The condition gradually improves on its own, but full recovery can take up to three years. The best recommendation is physiotherapy, focused on improving shoulder joint mobility.

Why the shoulder “freezes”

In frozen shoulder, the shoulder capsule surrounding the joint thickens, becomes stiff and tight, and thick bands of tissue called adhesions form. There is often less synovial fluid in such a joint, which is the fluid that allows easier gliding of tendons over the joint surfaces.

Roman Šiler, MSc Physiotherapy:
“Therapy and regular exercise greatly help in relieving pain and allow much faster restoration of shoulder joint mobility.”

Who is most likely to develop frozen shoulder syndrome

Frozen shoulder syndrome most commonly affects people between the ages of 40 and 60. It affects three percent of the population, occurs more often in women, and the risk is also higher in people with diabetes and thyroid disease. It can also develop if the shoulder has been immobilized for a long time in a position without movement, due to surgery, fracture, or other injury. However, it can occur in anyone.

What can trigger frozen shoulder syndrome (adhesive capsulitis)

Injury or repeated microtrauma in the shoulder girdle, which can cause inflammation and subsequently adhesions;
Diabetes or thyroid disease;
Lack of movement, resulting in stiff joints and muscles and therefore a higher risk of frozen shoulder;
Repetitive overuse in certain sports or occupational activities;
Genetic predisposition;
Autoimmune diseases that cause joint inflammation;
Surgery in the shoulder area.

Physiotherapy is very effective in frozen shoulder

If frozen shoulder syndrome occurs, do not delay visiting a physiotherapist, as physiotherapy will help restore shoulder joint mobility more quickly. The number of treatments depends on how severely the shoulder is affected and how it responds to physiotherapy procedures.

Physiotherapy includes:

pendulum exercises,
passive, active-assisted and active exercises,
stretching exercises,
strengthening exercises,
manual therapy (traction and joint mobilization),
recommendations for good posture, as poor posture leads to worse scapular kinematics and reduced arm function,
electrotherapy (interferential currents, ultrasound, TECAR, laser ...),
pain management advice.

Rehabilitation varies between individuals, therefore physiotherapy procedures also differ and change during treatment, depending on symptoms and the level of impairment.

It has been proven that the most effective treatment for frozen shoulder syndrome is physiotherapy, as it reduces pain and improves shoulder function. You can book physiotherapy at Terme Šmarješke Toplice, Terme Dolenjske Toplice, and Talaso Strunjan.