The Ins and Outs of Frozen Shoulder

Stiff shoulderIf you suffer from frozen shoulder (adhesive capsulitis), you may describe it as a painful and stiff shoulder. As this disease progresses, you can lose several degrees of motion.

Frozen shoulder consists of three clinical stages:

  1. Painful (freezing): gradual onset of diffuse shoulder pain o This may last 6 weeks to 9 months
  2. Stiff (frozen): during this phase, it becomes very difficult to move the shoulder and this often affects simple activities of daily living o This may last 4-6 months
  3. Thawing: gradual return of full motion Return to normal strength and motion can take up to 6-24 months

It can take several months to resolve a frozen shoulder. Successful treatment is typically obtained with measures to reduce pain and inflammation, in addition to a diligent physical therapy program.

Frozen shoulder usually affects patients between the ages of 40 and 60 and occurs with greater frequency in women. Patients with diabetes or thyroid disease are at increased risk of developing frozen shoulder.

The anatomy of frozen shoulder

The shoulder capsule surrounds the shoulder joint, like a balloon. In adhesive capsulitis, this tissue becomes inflamed, contracted, and stiff.

The cause of frozen shoulder

While more common in patients with diabetes, hypothyroidism, or those that have suffered a traumatic injury to the shoulder, most cases of adhesive capsulitis are of uncertain cause.

Symptoms of frozen shoulder

The hallmark symptoms of frozen shoulder are pain and stiffness. The pain typically resolves prior to resolution of the stiffness.

Diagnosis of frozen shoulder

Diagnosis can typically be established with a careful patient history and physical exam. Patients with frozen shoulder will have limitations in both “passive” and “active” range of motion. X-rays and MRI are occasionally obtained to rule out other disease, such as a rotator cuff tear.

Frozen shoulder treatment

Adhesive capsulitis will typically improve over time, but frustratingly, this may occur over 24 months. There are several interventions, however, that can expedite recovery.

Non-surgical treatment: most patients achieve a pain free shoulder with full range of motion without surgery. Non-surgical interventions include:

  • NSAIDs: medicines like Ibuprofen and Naprosyn reduce pain and inflammation and permit participation in a stretching program
  • Steroid injections: injections into the glenohumeral joint (the space between the ball and socket) are very successful at reducing pain and inflammation.
  • Brisement or hydrodilation: if the above procedures fail, the capsule is mechanically stretched by introducing a large volume of sterile fluid into the joint. This injection is performed under image-guidance.
  • Physical therapy: physical therapy is extremely important in restoring normal motion. Particular stretching exercises serve as the focus of therapy.

Surgery: a very small number of patients will fail to improve with the interventions described above. Surgery is sometimes recommended for these patients. Surgery includes:

  • Manipulation under anesthesia: the shoulder is manually stretched while the patient is asleep
  • Shoulder arthroscopy: the tight capsule is released to relieve it of its contracture

If you think you may be suffering from frozen shoulder, book an appointment today with Dr. David Dare. Dr. Dare is a fellowship-trained orthopedic surgeon specializing in sports medicine and shoulder surgery. His primary goal is to develop an effective treatment plan using the least invasive techniques to relieve your shoulder pain, restore function, and get you back to feeling your best. Call 919.781.5600  or fill out a form on this page.

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