Frozen shoulder, or adhesive capsulitis is a common condition affecting people generally between the ages of 40-65, especially in people with a history of diabetes, thyroid problems, Parkinson’s, or cardiac disease. Patients with frozen shoulder have progressive loss of range of motion and pain with any motion of the affected shoulder.
The shoulder is a ball and socket joint, but the anatomy of the shoulder allows for an amazing amount of flexibility. The humeral head, or ball, sits on the glenoid, a very shallow socket. It resembles a golf ball on a tee. Because the socket is so shallow, the shoulder relies on the soft tissue around the shoulder for stability. The labrum, a thickened cartilage layer around the glenoid, and the ligaments and capsule, provide a majority of the stability to the shoulder. The muscles of the rotator cuff and scapula also provide stability.
The cause of frozen shoulder is not understood. Patients with frozen shoulder have thickening of the capsule around the shoulder, which leads to pain and loss of motion. It is more common in diabetics, patients with thyroid disease, and patients who have had a previous shoulder injury and have been immobilized.
Patients with frozen shoulder usually have increasing pain as their shoulder loses motion. The pain is often exacerbated by quick motions of the shoulder. The shoulder becomes more painful as the stiffness worsens, and it is difficult even for other people to move the shoulder. Diagnosis is usually made by physical exam. Radiographs and MRI are often obtained to rule out other problems in the shoulder. Frozen shoulder has been divided into three stages:
Stage 1: “Freezing” Stage:
Characterized by a slow increase in pain, sometimes brought on by an apparently minor trauma. As the pain worsens, the shoulder loses motion.
Stage 2: “Frozen” Stage:
The pain improves, but the stiffness remains.
Stage 3: “Thawing” Stage:
Shoulder motion slowly returns to normal.
Stage 1 can last from 1 month to 9 months; stage 2 from 4 to 9 months, and stage 3 from 5 months to 2 years.
Frozen shoulder will usually get better on its own, although it takes considerable time (sometimes up to two or three years). Treatment is based on controlling pain and restoring motion.
The mainstay of treatment for frozen shoulder is aggressive physical therapy. A good therapist can help relieve pain and restore motion. Therapeutic exercises include stretching and range of motion exercises, followed by modalities such as heat and/or ice to improve symptoms. As with any physical therapy regime, a good home program is essential.
Oral anti-inflammatories (Naproxen, ibuprofen) can help relieve pain, especially in the “freezing” stage.
An injection of corticosteroid into the shoulder joint may allow for a more rapid recovery from frozen shoulder, especially if the diagnosis is made early in the disease process. The procedure is performed in the office, and often is done under ultrasound guidance in order to confirm that the injection is placed in the correct area.
More than 90% of patients improve without surgical treatment. However, in those few patients that do not get better with physical therapy and time, surgical intervention can be considered. Surgery involves an arthroscopic procedure to release the contracted tissue around the shoulder joint, followed by a manipulation to break up any other adhesions. The surgery is typically performed in an outpatient setting, and therapy commences a few days following the procedure. Recovery varies from six weeks to four months.