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Understanding Frozen Shoulder: Causes, Joints Involved, and Rehabilitation Exercises

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Frozen shoulder, or adhesive capsulitis, is a condition that leads to stiffness, pain, and limited movement in the shoulder joint. It can occur with or without tears in the rotator cuff muscles and significantly impacts daily activities. Understanding the involved structures and appropriate rehabilitation strategies can aid in recovery.


Joints Involved in Shoulder Movement

The shoulder is a complex system of joints that work together to facilitate movement. These include:

  1. Glenohumeral Joint – This is the ball-and-socket joint between the humerus (upper arm bone) and the glenoid cavity of the scapula (shoulder blade). Frozen shoulder directly affects this joint, causing a thickening of the joint capsule and restricting movement.

  2. Scapulothoracic Joint – This is where the scapula moves over the ribcage. In cases of frozen shoulder, movement at this joint can become severely restricted, reducing the overall range of motion.

  3. Sternoclavicular Joint – This joint connects the clavicle (collarbone) to the sternum (breastbone). While not commonly affected by frozen shoulder, its function is crucial for overall shoulder mechanics, particularly during arm elevation and rotation.


Frozen Shoulder with and without Rotator Cuff Tears

  • Without Rotator Cuff Tears: The primary issue is inflammation and thickening of the glenohumeral joint capsule, which limits movement and causes pain. While painful, conservative management through soft tissue work and movement exercises is often effective.

  • With Rotator Cuff Tears: The rotator cuff is a group of muscles and tendons stabilising the shoulder, including the supraspinatus, infraspinatus, teres minor, and subscapularis. A tear, particularly in the supraspinatus, can further impair movement and may require additional interventions such as targeted rehabilitation or, in some cases, surgical consideration.


The Role of Supraspinatus in Shoulder Movement

The supraspinatus muscle plays a key role in initiating shoulder abduction, that is lifting the arm away from the body to the side. It is responsible for lifting the arm for the first 15 degrees before the deltoid muscle takes over. In cases where supraspinatus function is compromised, lifting the arm can be difficult and painful, contributing to shoulder stiffness.


Gentle Exercises for Frozen Shoulder

Rehabilitation exercises aim to improve mobility while minimising pain. Here are some effective and gentle movements:

  1. Pendulum Exercises

    • Lean forward slightly, allowing the affected arm to hang freely.

    • Gently sway your arm in small circular motions and then in forward-backward and side-to-side directions.

    • This helps maintain mobility with minimal strain.

  2. Wall Climbing Exercise - Spider Hands

    • Stand facing a wall and use your fingertips to ‘walk’ your hand up the wall as high as comfortable.

    • Hold for a few seconds, then slowly lower it.

    • This promotes gradual stretching of the shoulder joint.

  3. Passive Shoulder Flexion

    • Use your unaffected hand to help lift your affected arm overhead while lying down or standing.

    • Hold for a few seconds and then lower it back down.

    • This encourages mobility without excessive strain.

  4. External Rotation with a Towel or Stick

    • Hold a towel or stick with both hands and gently push your affected arm outward with the assistance of the unaffected arm.

    • This helps improve external rotation, a movement often restricted in frozen shoulder.


Final Thoughts

Recovery from frozen shoulder can take time, often spanning months. Regular, gentle exercises combined with appropriate pain management strategies can significantly improve function. If there is a rotator cuff tear, additional rehabilitation measures may be needed. Consultation with a healthcare professional can help determine the best approach for each individual case. As a massage therapist I am unable to diagnose medical conditions so always advise my patients to seek primary care diagnosis. This may involve MRI scans and/or seeing a NHS physiotherapist. I always try to work complementary to other treatment modalities.


Clinical massage therapy can help with pain management as well as improving range of motion of the joints.


Supraspinatus muscle of the shoulder
Supraspinatus muscle of the shoulder

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