Frozen Shoulder
Description Frozen shoulder (adhesive capsulitis) is a disorder that causes pain and loss of motion or stiffness in the shoulder. It affects about two percent of the general population, and is more prevalent in women between the ages of 40 years to 70 years old. The causes of frozen shoulder are not fully understood. Frozen Shoulder is a thickening and contracture of the capsule surrounding the shoulder joint. A physician can diagnose frozen shoulder based on the patient’s history of shoulder symptoms and physical examination. To rule out other causes of the shoulder pain, such a a rotator cuff tear, physicians will order X-rays or MRI (magnetic resonance imaging) to confirm the diagnosis.
Risk Factors for Developing Frozen Shoulder: Occurs more in diabetic patients Patients with hypothyroidism, hyperthyroidism, Parkinson’s disease and cardiac disease have an increased risk for developing Frozen Shoulder Frozen Shoulder can be a result of a shoulder injury or if the shoulder has been immobilized for a period of time After a shoulder injury, one way to prevent getting Frozen Shoulder is to keep the shoulder mobilized.
Symptoms of Frozen Shoulder: Restricted motion or stiffness in the shoulder, where the patient can’t move the shoulder in a normal manner Dull or aching pain in the shoulder, which gets worse with attempted motion Pain is located over the outer shoulder area and sometimes the upper arm
The Three Stages of Frozen Shoulder: Stage one: In the "freezing" stage, which may last from six weeks to nine months, the patient develops a slow onset of pain. As the pain worsens, the shoulder loses motion. Stage two: The "frozen" stage is marked by a slow improvement in pain, but the stiffness remains. This stage generally lasts four months to nine months. Stage three: The final stage is the "thawing", during which shoulder motion slowly returns toward normal. This generally lasts five months to 26 months.
Treatment Options: Non-Surgical
Frozen shoulder will generally get better on its own. However, this takes time, sometimes up to two to three years. If you have a stiff and painful shoulder, see your physician to make sure no other injuries are present.
Treatment Goals:
- Get shoulder pain under control
- Restore shoulder motion
- Anti-inflammatory medications: i.g. Ibuprofen, Naprosyn
- Corticosteroid injections
- Physical Therapy to restore motion; includes stretching or range-of-motion exercises for the shoulder.
- Heat to help decrease pain
If the above treatment methods do not alleviate the pain, nerve blocks are sometimes used to limit pain and allow more aggressive physical therapy. Nerve blocks are effective and relieve pain in more than 90% of patients. These injections resolve the pain and improves shoulder range of motion.
However, there are a few cases that even after several years the motion does not return completely and a small amount of shoulder stiffness remains. In the long run, this small loss of motion does not seem to cause functional limitations.
Treatment Options: Surgical
Surgical intervention is considered when there is no improvement in pain or shoulder motion after an appropriate course of physical therapy and anti-inflammatory medications. When more invasive measures are considered, the patient must always consider that most individuals will get better if given sufficient time and that surgery always has risk involved. Surgical intervention is aimed at stretching or releasing the contracted joint capsule of the shoulder. The most common methods include manipulation under anesthesia and shoulder arthroscopy:
- Manipulation under anesthesia involves putting the patient to sleep and "manipulating" or forcing the shoulder to move. This process causes the capsule to stretch or tear.
- With shoulder arthroscopy, the surgeon makes several small incisions around the shoulder. A small camera and instruments are inserted through the incisions. They are used to cut through the tight portions of the joint capsule.
Often, manipulation and arthroscopy are used together in combination to obtain maximum results. Most patients have very good results with these procedures. After surgery, physical therapy is important to maintain the motion that was achieved with surgery. Recovery time varies. Some patients require a few weeks off of work depending on their occupation and speed of recovery.
