Shoulder

Frozen Shoulder

Adhesive Capsulitis is commonly referred to as “frozen shoulder.” It is a disorder characterized by pain and loss of motion or stiffness in the shoulder. The cause of frozen shoulder is not fully understood. The process involves thickening and contracture of the capsule surrounding the shoulder joint. Frozen shoulder can develop after a shoulder is injured or immobilized for a period of time. Attempts to prevent frozen shoulder include early motion of the shoulder after it has been injured.

Frozen shoulder affects about two percent of the general population. It is most common in women between 40-70 years old. It is also associated with a number of medical problems including:

  • Diabetes
  • Hypothyroidism
  • Hyperthyroidism
  • Parkinson's Disease
  • Cardiac disease

Symptoms

Pain due to frozen shoulder is usually dull or aching. It can be worsened with attempted motion. The pain is usually located over the outer shoulder area and sometimes the upper arm. The hallmark of the disorder is restricted motion or stiffness in the shoulder. The affected individual cannot move the shoulder normally. Motion is also limited when someone else attempts to move the shoulder for the patient. Some physicians have described the normal course of a frozen shoulder as having three stages:

  • Stage 1 – Freezing: A slow onset of pain that can last from six weeks to nine months. As the pain worsens, the shoulder loses motion.
  • Stage 2 – Frozen: Marked by a slow improvement in pain, but stiffness remains. This stage generally lasts four to nine months.
  • Stage 3 – Thawing: Shoulder motion slowly returns to normal over a five to 26 month period.

Diagnosis

A doctor can diagnose frozen shoulder based on the history of your symptoms and a physical examination. X-rays or MRI (magnetic resonance imaging) studies are sometimes used to rule out other causes of shoulder stiffness and pain, such as rotator cuff tear.

Treatment

Frozen shoulder will often get better on its own over time. Occasionally, improvement can take up to three years. If you have a stiff and painful shoulder, see your doctor to make sure that no other injuries are present.

Treatment is aimed at pain control and restoration of motion. Pain control can be achieved with anti-inflammatory medications taken orally or by injection. Physical therapy is implemented to restore motion. This may be under the direct supervision of a therapist or using a home program. Therapy includes stretching or range of motion exercises for the shoulder. Heat may be used to help decrease pain. Nerve blocks are sometimes used to limit pain and allow for more aggressive physical therapy. More than 90 percent of patients improve with these relatively simple treatments.

In some cases, full motion does not return completely and some stiffness remains after several years, but does not seem to cause functional limitations.

Surgical intervention is considered when there is no improvement in pain or shoulder motion after physical therapy and anti-inflammatory medications. Surgical intervention is aimed at stretching or releasing the contracted joint capsule of the shoulder. The most common methods include:

  • Manipulation under anesthesia so the surgeon can force your shoulder to move which causes the capsule to stretch or tear
  • Shoulder arthroscopy is a procedure where your surgeon makes several small incisions around the shoulder to cut through the tight portions of the joint capsule

Manipulation and arthroscopy are often used together to obtain maximum results. Most patients experience very good results with these procedures. After surgery, physical therapy is important to maintain the motion that was achieved through surgery. Recovery time varies. Some patients require six weeks to three months off work, depending on their occupation and speed of recovery.

 

Research on the Horizon
Although several theories exist, we do not know what causes frozen shoulder. Further research is needed to determine the exact cause, so that better preventative measures and treatments can be developed. Further research into the success of current treatments and whether they change the normal course of the disease would also be beneficial.

Information provided by the American Academy of Orthopaedic Surgeons.