Frozen Shoulder Treatment

Full Treatment Plan and Details

Who is this treatment for?

If any of the following apply to you, then this treatment plan is for you.

Signs and Symptoms

You may suffer from the following signs and symptoms. It is likely you may suffer from most of them, if not all:

• The insertion of the Deltoid muscle is painful.
• You are in pain during the night and cannot sleep on the affected shoulder.
• You feel pain almost whenever and however you move your arm.
• You are likely not able to lift your arm up to approximately 100° even if you get somebody else to lift it for you.
• You are likely not able to rotate your arm outwards by more than 30° or inwards by any more than 5°.

It is important that you do not self-diagnose the condition before deciding to go ahead with this treatment plan. Please consult your doctor or physician first as scans such as x-rays are likely needed to rule out any other condition. Frozen shoulder has often been over diagnosed[1,2] and has also been misdiagnosed in place of glenohumeral tuberculosis[3] and cancer[4–6].

You Tried Conventional Physio, but Are Unhappy with the Results or it did not Work.

This is not a requirement prior to engaging with us. However, if you are someone who has tried conventional physiotherapy and are not happy with the results or progress, then our frozen shoulder treatment plan may be what you are looking for.

There are numerous reasons why conventional physiotherapy probably hasn’t worked for you. These reasons could range from the following:

• You were not given very well defined exercise program[7].
• You were likely given exercises to perform on your own and at home where you were unable to ensure that you were performing the motions correctly. A study by Faber et al.[8] showed that only 24% of subjects who were all student physiotherapists performed exercises correctly.
• A combination of the severity of your condition and the exercise program prescribed to you could mean that your recovery could take a lot longer than initially thought. Upto 7 years in some cases[9].

Read more as to why conventional physiotherapy hasn’t worked for you and why our treatment method is far superior.

You Want to Avoid Undergoing Surgery for Your Frozen Shoulder

The usual step after conventional physiotherapy failure is surgery of some sort. These surgeries often involve permanent changes and/or damage[10] to your shoulder joint. There are numerous studies that encourage or recommend surgery especially for short-term results[11,12]. However, there is a chance that a recurrence of the same problem can occur[13]. We understand that people want to recover from their symptoms without having to undergo surgery.

We provide an alternative treatment plan that is designed to be far more effective than conventional physiotherapy with the aim to avoid surgery and restore good shoulder health.

You Want to Get Better and Get Better Quickly

You would not be here if you didn’t want this.

Who is this Treatment Not Suitable For?

You Have Not Yet Been Diagnosed to Have Frozen Shoulder

If you think you suffer from this condition and have not yet been diagnosed, you can view our other plans to help relieve you of your symptoms and help increase the health of your shoulder. In any case, we strongly advise that you visit your Doctor or physician to get a formal diagnosis so we can individualise your treatment and help you through to a full recovery.

Designed to be Better and Quicker than Conventional Physiotherapy

There are numerous studies that show physiotherapy works and recommends physiotherapy to treat Frozen Shoulder prior to considering surgery[15–18]. However, there are many patients who have undergone surgery. This is due to a complex range of factors. The main factors are as follows:

Conventional Physiotherapy is Taking Too Long

The conventional physiotherapy can take a long time to produce any real benefit or noticeable results. A few studies have shown that the condition can last on average upto 4.4 years and for some upto 20 years[9,15,19].

MUJO addresses this issue by combining the best device and technological design and best therapy practice to ensure you get the most efficient treatment as possible.

Surgery Does Work (to an extent)

Surgery works in the short-term[11,12] and results are noticed almost immediately in comparison to conventional physiotherapy.

We encourage all patients to try their best to avoid any surgery as it does involve permanent changes and can involve damage to the joint[10]. Our treatment method is designed to be the best non-invasive alternative option and we encourage all frozen shoulder patients to engage with us before opting for any type of injection or surgery.

Difficult to Comply to the Conventional Physiotherapy Exercise Program

Many if not most patients are unable to comply with the exercise program for numerous reasons. These reasons include but are not limited to the following: Patients are unable to perform the exact exercise motion[8], patients decide not to perform the exercise and patients do not notice a benefit immediately and thus can become demotivated.

MUJO devices are designed to ensure that every single repetition is the same, whether you are supervised or you decide to perform the exercises yourself. Many MUJO users have reported to feel and see an immediate benefit (even after the very first session) in comparison to other non-invasive treatment methods.

Taylor 2014[20] found that exercises classes were better than individual therapy in treating frozen shoulder syndrome. This is likely due to added motivation by other fellow patients. MUJO have incorporated an app, which provides a visual feedback of each repetition. Your goal as well as your current position is shown on screen while you exercise. Many of our users have stated that the visual feedback along with results data provided motivate them further and make the exercises sessions enjoyable and a pleasure to engage in.

Exercises and the Exercise Program was Poorly Defined

Exercises and exercise details are not properly defined or conveyed to you by your therapist. Toigo et al.[7] have defined an extensive list of what needs to be defined in an exercise program to reap maximum benefits and to avoid pitfalls. Some of these include the speed of each repetition, the speed of outward motion, the speed of inward motion and the length of hold and rest times during and between each rep. It is very likely that these details were not conveyed to you by your therapist.

All our exercise programs are wholly defined and we do not miss any details. Our app guides you to ensure each exercise repetition and set is performed correctly.

Conventional Physiotherapy Does Not Target Other Affected Muscles

Other muscles around the shoulder such as your Trapezius and Serratus Anterior can become overactivated due to a frozen shoulder[21]. The exercise program given to patients by their physiotherapist would not necessarily include exercises to help relearn normal muscle activation patterns or help keep the other muscles healthy.

MUJO address this issue in two ways. Firstly, our devices are designed to target shoulder muscles in a way as to ensure that other surrounding muscles are not used to compensate for the lack of strength. Secondly, our treatment methods also include exercises that target the surrounding muscles in a way to ensure that they are kept healthy and muscle activation patterns are relearned to ensure no further damage is done to the surrounding muscles.

Best Practice

A recent study by Barrett et al.[16] implied that best practice and treatment are active approaches. They suggest the use of PNF exercises and active stretching to best treat frozen shoulder syndrome.

MUJO have two shoulder devices. The Internal device is primarily used to warm up and actively stretch the muscles surrounding the shoulder joint and the soft-tissues within the joint safely. The External device is then used to exercise your shoulder. Both of our devices allow PNF exercises that can be repeated with great accuracy due to the visual feedback in our app and mechanical constraints that can be applied on our devices.

References

[1]       Robinson CM, Seah KTM, Chee YH, et al. Frozen shoulder. Bone Joint J. [Internet]. 2012 [cited 2017 Mar 9];94–B:1–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22219239.

[2]       Wiley AM. Arthroscopic appearance of frozen shoulder. Arthrosc. J. Arthrosc. Relat. Surg. [Internet]. 1991 [cited 2017 Mar 9];7:138–143. Available from: http://linkinghub.elsevier.com/retrieve/pii/074980639190098I.[3]       Li J, Tang K, Xu H, et al. Glenohumeral joint tuberculosis that mimics frozen shoulder: a retrospective analysis. J. Shoulder Elb. Surg. [Internet]. 2012 [cited 2017 Mar 3];21:1207–1212. Available from: http://linkinghub.elsevier.com/retrieve/pii/S1058274611003806.[4]       Sano H, Hatori M, Mineta M, et al. Tumors masked as frozen shoulders: A retrospective analysis. J. Shoulder Elb. Surg. [Internet]. 2010 [cited 2017 Mar 9];19:262–266. Available from: http://linkinghub.elsevier.com/retrieve/pii/S1058274609002353.[5]       Watanabe T, Suenaga N, Minami A. Extra-abdominal desmoid around the shoulder joint: one of the differential diagnoses of frozen shoulder. J. Shoulder Elb. Surg. [Internet]. 2004 [cited 2017 Mar 9];13:90–94. Available from: http://linkinghub.elsevier.com/retrieve/pii/S1058274603000545.[6]      Robinson D, Halperin N, Agar G, et al. Shoulder girdle neoplasms mimicking frozen shoulder syndrome. J. Shoulder Elb. Surg. [Internet]. 2003 [cited 2017 Mar 6];12:451–455. Available from: http://linkinghub.elsevier.com/retrieve/pii/S1058274603000922.[7]       Toigo M, Boutellier U. New fundamental resistance exercise determinants of molecular and cellular muscle adaptations. Eur. J. Appl. Physiol. 2006;97:643–663.[8]       Faber M, Andersen MH, Sevel C, et al. The majority are not performing home-exercises correctly two weeks after their initial instruction—an assessor-blinded study. Lafeber F, editor. PeerJ [Internet]. 2015;3:e1102. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4517955/.[9]      Shaffer B, Tibone JE, Kerlan RK. Frozen shoulder. A long-term follow-up. J. Bone Joint Surg. Am. [Internet]. 1992 [cited 2017 Mar 9];74:738–746. Available from: http://www.ncbi.nlm.nih.gov/pubmed/1624489.[10]     Sasanuma H, Sugimoto H, Kanaya Y, et al. Magnetic resonance imaging and short-term clinical results of severe frozen shoulder treated with manipulation under ultrasound-guided cervical nerve root block. J. Shoulder Elb. Surg. 2016;25:e13–e20.[11]      Nagata H, Thomas WJC, Woods DA. The management of secondary frozen shoulder after anterior shoulder dislocation – The results of manipulation under anaesthesia and injection. J. Orthop. 2016;13:100–105.[12]     Jenkins EF, Thomas WJC, Corcoran JP, et al. The outcome of manipulation under general anesthesia for the management of frozen shoulder in patients with diabetes mellitus. J. Shoulder Elb. Surg. 2012;21:1492–1498.[13]     Cameron RI, McMillan J, Kelly IG. Recurrence of a “primary frozen shoulder”: A case report. J. Shoulder Elb. Surg. [Internet]. 2000 [cited 2017 Mar 6];9:65–67. Available from: http://linkinghub.elsevier.com/retrieve/pii/S1058274600900119.[14]     Rockwood Jr. CA, Matsen III FA, Wirth MA, et al. The Shoulder. Fourth. Philadelphia: Saunders Elsevier; 2009.[15]     Le Lievre H, Murrell G. Long-term outcomes of arthroscopic capsular release for frozen shoulder. J. Sci. Med. Sport [Internet]. 2010 [cited 2017 Mar 6];13:e36. Available from: http://linkinghub.elsevier.com/retrieve/pii/S1440244010007395.[16]     Barrett E, de Burca N, McCreesh K, et al. The effectiveness of conservative treatments in the management of idiopathic frozen shoulder: A systematic review of randomised controlled trials. Man. Ther. 2016;25:e60–e61.[17]     Celik D, Kaya Mutlu E. Does adding mobilization to stretching improve outcomes for people with frozen shoulder? A randomized controlled clinical trial. Clin. Rehabil. 2016;[18]     Jain TK, Sharma NK. The effectiveness of physiotherapeutic interventions in treatment of frozen shoulder/adhesive capsulitis: A systematic review. J. Back Musculoskelet. Rehabil. 2014.[19]     Hand C, Clipsham K, Rees JL, et al. Long-term outcome of frozen shoulder. J. Shoulder Elb. Surg. [Internet]. 2008 [cited 2017 Mar 3];17:231–236. Available from: http://linkinghub.elsevier.com/retrieve/pii/S1058274607004867.[20]    Taylor N. Exercise classes supervised by a physiotherapist may be better at restoring function after frozen shoulder than individual physiotherapy. J. Physiother. 2014.[21]     Kim J-M, Lim K-B, Joo S-J, et al. Course Number 433: Electrodiagnostic Medicine Dynamic Electromyographic Activities of Scapulothoracic Muscles in Patients With Frozen Shoulder Syndrome. Arch. Phys. Med. Rehabil. [Internet]. 2007 [cited 2017 Mar 6];88:E1. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0003999307008453.