Frozen Shoulder

Have you had an annoying pain in your shoulder for weeks or months, but you cannot recall injuring yourself?  Are you unable to enjoy sports like tennis or golf because the pain and stiffness in your shoulder is getting worse? Is the pain beginning to keep you awake at night?  If any of this sounds familiar, you may have frozen shoulder.

What is a frozen shoulder?

The shoulder joint is a ball and socket joint surrounded by a capsule of tissue.  Frozen shoulder, also known as adhesive capsulitis, is a common condition in which the sac of ligaments surrounding the joint, also known as the articular shoulder capsule, swells and stiffens, restricting mobility.

Risk factors for frozen shoulder

Most of the time there is no cause for frozen shoulder; however, people who sustain a shoulder injury or undergo surgery on the shoulder can develop a frozen shoulder.

Frozen shoulder most commonly affects people between the ages of 40 to 60 years old, and it is twice as common in women as it is in men.  An increased likelihood of developing frozen shoulder is linked to the following chronic medical conditions:

• Diabetes
• Parkinson’s disease
• Cardiac disease or surgery
• Hyperthyroidism
• Hypothyroidism

What are the symptoms and stages of frozen shoulder?

Frozen shoulder typically develops slowly and has three stages. Each of these stages can last a number of months.

• Painful stage – During this stage, pain occurs with any movement of your shoulder, and your shoulder’s range of motion begins to be limited.  You may also experience muscle spasms.
• Frozen stage - Pain may begin to diminish at night and at rest during this stage, however, your shoulder becomes stiffer, and you experience a notable decrease in your range of motion.
• Thawing stage -Pain decreases and the range of motion in your shoulder begins to improve.

How is a frozen shoulder diagnosed?

It is very important to see your doctor or therapist for a proper diagnosis and to rule out any other possibilities, such as a rotator cuff tear.  Your doctor may have you perform certain movements to determine pain and range of motion.  If necessary, diagnosis can also be confirmed by arthrography, which is a procedure where an x-ray contrast dye is injected into the shoulder joint.  The tissues of the shoulder can also be evaluated with an MRI scan.

What is the treatment for a frozen shoulder?

There are various treatments for frozen shoulder, and early and accurate diagnosis is imperative.  In patients with frozen shoulder, the goal of treatment is pain reduction and the preservation of shoulder mobility.  Over 90% of patients improve with non-surgical treatments, including the following:

• Medications
  • Non-steroidal anti-inflammatory drugs (NSAIDs), such as Aspirin, Ibuprofen and Naproxen, may be helpful in offering relief from the painful symptoms.
  • Muscle relaxants are helpful in the early stages of the disease when spasm is predominant.
  • Low-dose antidepressant medications may help to avoid a cycle of sleep disturbance leading to a chronic pain syndrome.
•  Corticosteroid injections are commonly used to decrease the inflammation in the frozen shoulder joint and allow for more stretching and physical therapy.  Cortisone is only effective when used in conjunction with physical therapy for the management of a frozen shoulder.
•  Physical therapy - Physical therapists can develop a specific stretching and strengthening exercise program for you, administrate manual therapy techniques and also incorporate ultrasound, ice or heat into the rehabilitation for frozen shoulder.  Physical therapy can take weeks to months to achieve a recovery, depending on the severity of the scarring of the tissues around the shoulder.

What is the prognosis of a frozen shoulder?

The prognosis for a frozen shoulder depends on its response to physical therapy, exercises, and treatments as described above. The vast majority of patients who develop a frozen shoulder will recover their functional motion with therapy and stretching alone.  The return to normal motion and strength usually takes from 6 months to 2 years.

Will I need surgery for frozen shoulder?

Sometimes a frozen shoulder is resistant to physical therapy, and you and your doctor may need to discuss whether surgery can help your condition.  The goal of surgery for frozen shoulder is to stretch and release the stiffened joint capsule.  There are two main types of surgery that can be performed:

• Shoulder manipulation is done under general anesthesia (you are unconscious and would not feel anything) as the doctor attempts to loosen tightened tissue by moving the shoulder joint around.
• The second type is minimally invasive arthroscopic surgery, where a small incision is made in the shoulder to repair the tissue around the shoulder joint.

If you are experiencing pain that is localized to the shoulder and is affecting your range of motion, it may be frozen shoulder, and it is important to make an appointment with your primary care physician as soon as possible for proper diagnosis.