Frozen Shoulder

What is frozen shoulder?

Frozen shoulder, also called adhesive capsulitis, is a painful condition in which the movement of the shoulder becomes limited.

Frozen shoulder occurs when the strong connective tissue surrounding the shoulder joint (called the shoulder joint capsule) become thick, stiff, and inflamed. (The joint capsule contains the ligaments that attach the top of the upper arm bone [humeral head] to the shoulder socket [glenoid], firmly holding the joint in place. This is more commonly known as the "ball and socket" joint.)

The condition is called "frozen" shoulder because the more pain that is felt, the less likely the shoulder will be used. Lack of use causes the shoulder capsule to thicken and becomes tight, making the shoulder even more difficult to move -- it is "frozen" in its position.

Who is at risk for developing frozen shoulder?

Age: Adults, most commonly between 40 and 60 years old.

Gender: More common in women than men.

Recent shoulder injury: Any shoulder injury or surgery that results in the need to keep the shoulder from moving (i.e., by using a shoulder brace, sling, shoulder wrap, etc.). Examples include a rotator cuff tear and fractures of the shoulder blade, collarbone or upper arm.

Diabetes: Between 10 and 20 percent of individuals with diabetes mellitus develop frozen shoulder.

Other health diseases and conditions: Includes stroke, hypothyroidism (underactive thyroid gland), hyperthyroidism (overactive thyroid gland), Parkinson’s disease and heart disease. Stroke is a risk factor for frozen shoulder because movement of an arm and shoulder may be limited. Why other diseases and conditions increase the risk of developing a frozen shoulder is not clear.

What are the signs and symptoms of frozen shoulder?

Symptoms of frozen shoulder are divided into three stages:

• The "freezing" stage:
  In this stage, the shoulder becomes stiff and is painful to move. The pain slowly increases. It may worsen at night. Inability to move the shoulder increases. This stage lasts 6 weeks to 9 months.
• The "frozen" stage:
  In this stage, pain may lessen, but the shoulder remains stiff. This makes it more difficult to complete daily tasks and activities. This stage lasts 2 to 6 months.
• The "thawing" (recovery) stage:
  In this stage, pain lessens, and ability to move the shoulder slowly improves. Full or near full recovery occurs as normal strength and motion return. The stage lasts 6 months to 2 years.

How is frozen shoulder diagnosed?

To diagnose frozen shoulder, your doctor will:

• Discuss your symptoms and review your medical history.
• Conduct a physical exam of your arms and shoulders:
  • The doctor will move your shoulder in all directions to check the range of motion and if there is pain with movement. This type of exam, in which your doctor is moving your arm and not you, is called determining your “passive range of motion.”
  • The doctor will also watch you move your shoulder to see your “active range of motion.”
  • The two types of motion are compared. People with frozen shoulder have limited range of both active and passive motion.
• X-rays of the shoulder are also routinely obtained to make sure the cause of the symptoms is not due to another problem with the shoulder, such as arthritis. Advanced imaging tests, such as magnetic resonance imaging (MRI) and ultrasound, are usually not needed to diagnose frozen shoulder. They may be taken to look for other problems, such as a rotator cuff tear.

What are the treatments for frozen shoulder?

Treatment usually involves pain relief methods until the initial phase passes. If the problem persists, therapy and surgery may be needed to regain motion if it doesn’t return on its own.

Some simple treatments include:

• Hot and cold compresses. These help reduce pain and swelling.
• Medicines that reduce pain and swelling. These include nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil®, Motrin®), and acetaminophen (Tylenol®). Other painkiller/anti-inflammatory drugs may be prescribed by your doctor. More severe pain and swelling may be managed by steroid injections. A corticosteroid, such as cortisone, is injected directly into the shoulder joint.
• Physical therapy. Stretching and range of motion exercises taught by a physical therapist.
• Home exercise program. Continue exercise program at home.
• Transcutaneous electrical nerve stimulation (TENS). Use of a small battery-operated device that reduces pain by blocking nerve impulses.

If these simple treatments have not relieved pain and shoulder stiffness after about a year trial, other procedures may be tried. These include:

• Manipulation under anesthesia: During this surgery, you will be put to sleep and your doctor will force movement of your shoulder. This will cause the joint capsule to stretch or tear to loosen the tightness. This will lead to an increase in the range of motion.
• Shoulder arthroscopy: Your doctor will cut through the tight parts of your joint capsule (capsular release). Small pencil-sized instruments are inserted through small cuts around your shoulder.

These two procedures are often used together to get better results.

Can frozen shoulder be prevented?

The chance of a frozen shoulder can be prevented or at least lessened if physical therapy is started shortly after any shoulder injury in which shoulder movement is painful or difficult. Your orthopaedic doctor or physical therapist can develop an exercise program to meet your specific needs.

What’s the outlook for frozen shoulder?

Simple treatments, such as use of pain relievers and shoulder exercises, in combination with a cortisone injection, are often enough to restore motion and function within a year or less. Even left completely untreated, range of motion and use of the shoulder continue to get better on their own, but often over a slower course of time. Full or nearly full recovery is seen after about two years.