Frozen Shoulder

What is a frozen shoulder?

Frozen shoulder is a condition in which the tissues in the shoulder joint become thicker and tighter over time. This leads to limited range of motion, as the shoulder joint no longer has space to rotate properly. Also known as adhesive capsulitis, frozen shoulder is most common in patients between the ages of 40 and 60.

In a healthy shoulder, the upper arm, shoulder blade and collarbone are joined by muscles and tendons in the shoulder capsule. Synovial fluid lubricates the joint for smooth, pain-free movement.

In a frozen shoulder, the tissues in the shoulder capsule thicken and tighten. Stiff scar tissue called adhesions develop and synovial fluid decreases, leading to pain and lack of range of motion in the shoulder. Oftentimes frozen shoulder occurs as a result of unregulated inflammatory tissue in the shoulder leading to excess inflammation of the shoulder capsule – hence the name adhesive capsulitis.

Frozen shoulder causes

The causes of frozen shoulder are multifactorial. The condition is seen commonly in people with endocrine abnormalities such as Diabetes and Thyroid disorders. In addition – perimenopausal women are oftentimes afflicted with adhesive capsulitis. Other causes of frozen shoulder can include extended periods of shoulder immobilization. Some cases of frozen shoulder are caused by long periods of shoulder immobilization. Patients who have undergone a mastectomy, arm or shoulder surgery, or who have had their arm immobilized while a fracture is healing, are more likely to experience a frozen shoulder.
Risk factors for frozen shoulder

Certain people are more likely to experience a frozen shoulder than others. Some medical conditions increase the likelihood of suffering from a frozen shoulder, as does age and gender. Populations that are more likely to suffer from a frozen shoulder include:

• Women
• People between the ages of 40 and 60
• Diabetics
• People with over- or under-active thyroid
• Cardiovascular disease patients
• Tuberculosis patients
• People with Parkinson’s disease
• Stroke patients who have trouble moving their arm

How does frozen shoulder develop?

Frozen shoulder tends to develop slowly, over a period of weeks or months. The first sign of frozen shoulder is shoulder pain, which develops into more and more difficulty moving the shoulder. There are three phases of frozen shoulder development:

Phase 1 – The Freezing Stage – In this stage, the shoulder becomes painful and range of motion slowly decreases. The freezing stage generally occurs over six to nine weeks.

Phase 2 – The Frozen Stage – The frozen stage is when the shoulder is stiff and immobile, though usually the shoulder is less painful in the frozen stage than the freezing stage. This stage generally lasts for many months.

Phase 3 – The Thawing Stage – Frozen shoulders generally improve on their own over the course of a couple years. Most frozen shoulders are able to return to their prior level of function, strength and range of motion without treatment.

How a frozen shoulder is diagnosed

To diagnose a frozen shoulder, a physician generally starts by asking the patient to move the affected arm into different positions to assess the patient’s level of pain and range of motion. Frozen shoulder affects both passive and active range of motion. By asking the patient to move the affected arm, the physician is able to determine active range of motion. The physician will also ask the patient to relax while he or she moves the arm for the patient, which will determine passive range of motion.

Many cases of frozen shoulder can be diagnosed with only a physical examination and medical history. On some occasions, however, addition testing may be required, including X-rays, ultrasounds or an MRI. These additional tests can be helpful for ruling out other health conditions with similar symptoms to frozen shoulder.

Treatments for Frozen Shoulder

Treatment for frozen shoulder focuses on reducing pain and restoring range of motion in the affected shoulder. Depending on the severity of the frozen shoulder, many different treatments are available.

Medication – Over-the-counter pain relievers such as ibuprofen are commonly prescribed to reduce pain and inflammation of a frozen shoulder. Sometimes, prescription pain relievers are prescribed if over-the-counter medications do not provide the right level of relief.

Physical Therapy – Physical therapy can be particularly helpful for frozen shoulder patients. A physical therapist can teach patients range-of-motion exercises that will help loosen the tightened tissues in the shoulder joint and restore healthy movement.

Shoulder manipulation – Under general anesthesia, a physician will move the patient’s shoulder into different positions to help loosen the tightened tissues. General anesthesia is used to prevent the patient from feeling pain during the procedure. This is a non-invasive method of frozen shoulder treatment.

Steroid injections – Corticosteroid injections placed in the shoulder joint can help to reduce pain and improve range of motion in the shoulder. Steroid injections are a common treatment in the beginning stages of frozen shoulder.

Joint distention – In joint distention, sterile water is injected into the shoulder joint to stretch the capsule and provide more room for the shoulder joint to move properly.

When to have frozen shoulder surgery

Most cases of frozen shoulder recover on their own one to two years after the onset of symptoms. But in some cases, such as those with persistent symptoms that do not clear after non-surgical treatments, frozen shoulder surgery may be necessary. Surgery is generally a last resort treatment for frozen shoulder, as non-surgical methods are usually sufficient to treat the patient’s symptoms.

The purpose of frozen shoulder surgery is to release scar tissue, adhesions, and other anatomical abnormalities that are preventing the shoulder from moving normally. Frozen shoulder surgery is generally done with arthroscopy, using a tiny camera to help the surgeon visualize the structures inside the shoulder. Small incisions are made, and the arthroscope is inserted along with other miniature surgical tools.

Recovery time for frozen shoulder surgery is approximately three to six months. During that time, the patient will undergo physical therapy and participate in at-home exercises to keep the shoulder mobile while it is healing. This prevents a recurrence of frozen shoulder.