Frozen Shoulder
What is Frozen Shoulder (Adhesive Capsulitis)?
Adhesive capsulitis, more commonly referred to as frozen shoulder, is a condition that causes pain and limited range of motion in the shoulder. It can be very painful and over time the stiffness can significantly impact an individual’s ability to perform their daily activities. Fortunately, the disease typically is self-limiting and after a period of worsening symptoms, the shoulder tends to get better, though it can take up to a few years to fully resolve.
Frozen shoulder occurs when the shoulder capsule becomes thickened and tight, causing stiffness of the shoulder. Thick bands of tissue called adhesions form in the shoulder joint that contribute to the stiffness. In addition, there is also less synovial fluid, which is the normal lubricating liquid that helps the joint move smoothly.
The primary symptoms of frozen shoulder are severe pain and significantly limited movement in the shoulder, even with the help of someone else. The pain is usually dull or aching and located over the outer shoulder area and sometimes in the upper arm. Sometimes sharp pain can occur if the arm is bumped or moved suddenly. The pain is usually worst in the early course of the disease. It can often progress to the point that simple movements and daily activities are either impossible or incredibly painful.
Frozen shoulder is relatively common and can happen to anyone at any time. However, it typically affects patients between the ages of 40 and 70. Women are more commonly affected than men. Certain other conditions increase the risk of getting frozen shoulder. These conditions include diabetes, thyroid disease, rheumatoid arthritis, Parkinson’s, or certain heart and lung conditions. An injury or recent surgery may also cause frozen shoulder to develop.
The exact cause of frozen shoulder is not fully understood. However, there are certain conditions previously mentioned that increase your chances of developing frozen shoulder. It can also occur when the shoulder has been immobilized for a period of time, either after an injury, surgery, or fracture. There is no clear connection to a specific line of work or hand dominance.
Typically, frozen shoulder can be diagnosed based on patient history, symptoms, and physical exam. The main characteristic of frozen shoulder is a limitation of both active and passive range of motion. Active range of motion occurs when you move your shoulder on your own. Passive range of motion occurs when someone else moves your shoulder. Patients with frozen shoulder demonstrate limited range of motion both actively and passively. The decrease in shoulder motion results from the tight capsule and adhesions restricting the motion of the joint. In addition to a physical exam, your doctor will also ask you questions about the other health conditions mentioned above, or recent injuries that may point to a cause for your frozen shoulder.
If needed, a variety of imaging techniques can be used to help make the diagnosis and rule out other causes of stiffness and pain in the shoulder. Studies such as MRI or ultrasound can be used to evaluate the tissue surrounding the shoulder joint to help identify other soft tissue injuries in your shoulder.
Yes, fortunately a frozen shoulder generally gets better over time without surgery, though it may take a considerable amount of time. Frozen shoulder progresses through 3 general phases of disease. The 3 phases are (1) “freezing” (2) “frozen” and (3) “thawing” stages. The “freezing” stage is the onset of disease with gradually increasing pain and stiffness. As the pain gets worse, so does the motion. This phase can last from 6 weeks to 9 months. The “frozen” stage may see improvements in pain, but the stiffness remains, making daily activities difficult. This phase may last 4 to 6 months or even a year. Finally, the “thawing” stage describes the slow improvement of motion. Ultimately, allowing for complete return to normal or near normal strength and motion can take anywhere from 6 months to 2 years.
Treatment focuses on pain control and improvement of shoulder strength and range of motion. Treatments typically begin with medications and physical therapy. It is critical to optimize your other health conditions that might be contributing to your frozen shoulder. As an example, if you are diabetic, work with your primary care physician or endocrinologist to develop a plan for optimized blood sugar control, which may help accelerate your recovery through the stages of frozen shoulder. For the pain and inflammation, over-the-counter-medications such as non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used. Sometimes a steroid can be injected directly into your shoulder for a powerful anti-inflammatory effect. Working with a well-trained physical therapist to perform specific exercises to help restore motion can be successful. Stretching and range of motion exercises can also be performed as part of a home exercise program.
If these treatment options do not work, surgical intervention is a more aggressive option. Surgery may be offered during the “frozen” stage of disease with the goal of stretching and releasing the stiffened joint capsule. Surgical techniques include manipulation under anesthesia, during which the patient is put to sleep and the doctor moves the shoulder through a complete range of motion in a forceful, yet controlled manner. This manipulation attempts to stretch out and break up the tight scar tissue around the joint. In very severe cases, arthroscopic surgery to cut through the tight portions of the capsule may accompany a manipulation to obtain maximum results.
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