Frozen Shoulder

Contents

• What is frozen shoulder? An overview
• What are the other common names for Frozen Shoulder?
• Know the anatomy of shoulder joint.
• What is the cause of frozen shoulder?
• Who is at risk for developing frozen shoulder?
• What are the signs and symptoms of frozen shoulder?
• How is frozen shoulder diagnosed?
• What are the treatments for frozen shoulder?
• Can frozen shoulder be prevented?
• What’s the outlook for frozen shoulder?

What is frozen shoulder? An overview

Frozen shoulder, also called adhesive capsulitis, is a painful condition in which the movement of the shoulder becomes limited. Signs and symptoms typically begin gradually, worsen over time and then resolve, usually within one to three years.

The condition is called “frozen” shoulder because the more pain that is felt, the less likely the shoulder will be used. Lack of use causes the shoulder capsule to thicken and becomes tight, making the shoulder even more difficult to move — it is “frozen” in its position.

Frozen shoulder most commonly affects people between the ages of 40 and 60, and occurs in women more often than men. In addition, people with diabetes are at an increased risk for developing frozen shoulder. Your risk of developing frozen shoulder increases if you’re recovering from a medical condition or procedure that prevents you from moving your arm — such as a stroke or a mastectomy.

Treatment for frozen shoulder involves range-of-motion exercises and, sometimes, corticosteroids and numbing medications injected into the joint capsule. Physical therapy, with a focus on shoulder flexibility, is the primary treatment recommendation for frozen shoulder. In a small percentage of cases, arthroscopic surgery may be indicated to loosen the joint capsule so that it can move more freely.

It’s unusual for frozen shoulder to recur in the same shoulder, but some people can develop it in the opposite shoulder.

What are the other names for Frozen Shoulder?

1. Adhesive capsulitis
2. Painful stiff shoulder
3. Periarthritis

Know the anatomy of shoulder joint

Your shoulder is a ball-and-socket joint made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle).

The head of the upper arm bone fits into a shallow socket in your shoulder blade. Strong connective tissue, called the shoulder capsule, surrounds the joint. The joint capsule contains the ligaments that attach the top of the upper arm bone [humeral head] to the shoulder socket [glenoid], firmly holding the joint in place. This is more commonly known as the “ball and socket” joint

To help your shoulder move more easily, synovial fluid lubricates the shoulder capsule and the joint.

What is the cause of frozen shoulder?

Frozen shoulder occurs when the strong connective tissue surrounding the shoulder joint (called the shoulder joint capsule) become thick, stiff, and inflamed restricting its movement.

Doctors aren’t sure why this happens to some people, although it’s more likely to occur in people who

• have diabetes or
• recently had to immobilize their shoulder for a long period, such as after surgery or an arm fracture.

Who is at risk for developing frozen shoulder?

1. Age: Adults, most commonly between 40 and 60 years old.
2. Gender: More common in women than men.
3. Recent shoulder injury: Any shoulder injury or surgery that results in the need to keep the shoulder from moving (i.e., by using a shoulder brace, sling, shoulder wrap, etc.). Examples include a rotator cuff tear and fractures of the shoulder blade, collarbone or upper arm.
4. Diabetes: Between 10 and 20 percent of individuals with diabetes mellitus develop frozen shoulder.
5. Other health diseases and conditions: Includes stroke, hypothyroidism (underactive thyroid gland), hyperthyroidism (overactive thyroid gland), Parkinson’s disease and heart disease. Stroke is a risk factor for frozen shoulder because movement of an arm and shoulder may be limited. Why other diseases and conditions increase the risk of developing a frozen shoulder is not clear.

What are the signs and symptoms of frozen shoulder?

Frozen shoulder typically develops slowly, and symptoms are divided into three stages. Each stage can last a number of months.:

1. The “freezing” (painful) stage:

In this stage, the shoulder becomes stiff and is painful to move. The pain slowly increases. It may worsen at night, sometimes disturbing sleep. Inability to move the shoulder increases. This stage lasts 6 weeks to 9 months.

• The “frozen” (stiffening) stage:

In this stage, pain may lessen, but the shoulder remains stiff. This makes it more difficult to complete daily tasks and activities. This phase may occur at around 4 months and last till about 12 months.

• The “thawing” (recovery) stage:

In this stage, pain lessens, and ability to move the shoulder slowly improves. Full or near full recovery occurs as normal strength and motion return. It is estimated that 15% may have persistent pain and long-term disability. Effective treatments which shorten the duration of the symptoms and disability will have a significant value on reducing the morbidity. The stage lasts 6 months to 2 years.

How is frozen shoulder diagnosed?

To diagnose frozen shoulder, your doctor may ask some of the following questions:

• When did your symptoms begin?
• Are there activities that worsen your symptoms?
• Have you ever injured that shoulder? If so, how?
• Do you have diabetes?
• Have you had any recent surgeries or periods of restricted shoulder motion?

And conduct a physical exam of your arms and shoulders:

• The doctor will move your shoulder in all directions to check the range of motion and if there is pain with movement. This type of exam, in which your doctor is moving your arm and not you, is called determining your “passive range of motion.”
• The doctor will also watch you move your shoulder to see your “active range of motion.”
• The two types of motion are compared. People with frozen shoulder have limited range of both active and passive motion.

What are the treatments for frozen shoulder?

Treatment usually involves pain relief methods until the initial phase passes. If the problem persists, therapy and surgery may be needed to regain motion if it doesn’t return on its own.

1. Some simple treatments include:

a) Hot and cold compresses. These helps reduce pain and swelling.

b) Medicines that reduce pain and swelling. These include nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, and acetaminophen. Other painkiller/anti-inflammatory drugs may be prescribed by your doctor.

c) Physical therapy. Stretching and range of motion exercises taught by a physical therapist. Below are examples of some of the exercises that might be recommended:

-External rotation — passive stretch. Stand in a doorway and bend your affected arm’s elbow to 90 degrees to reach the doorjamb. Keep your hand in place and rotate your body as shown in the illustration. Hold for 30 seconds. Relax and repeat.

-Forward flexion — supine position. Lie on your back with your legs straight. Use your unaffected arm to lift your affected arm overhead until you feel a gentle stretch. Hold for 15 seconds and slowly lower to start position. Relax and repeat.

-Crossover arm stretch. Gently pull one arm across your chest just below your chin as far as possible without causing pain. Hold for 30 seconds. Relax and repeat.

• 2. Transcutaneous electrical nerve stimulation (TENS).
  • Use of a small battery-operated device that reduces pain by blocking nerve impulses.
  • A TENS unit delivers a tiny electrical current to key points on a nerve pathway.
  • The current, delivered through electrodes taped to your skin, isn’t painful or harmful.
  • It’s not known exactly how TENS works, but it’s thought that it might stimulate the release of pain-inhibiting molecules (endorphins) or block pain fibers that carry pain impulses.
• 3. Surgical and other procedures

Most frozen shoulders get better on their own within 12 to 18 months. If these simple treatments have not relieved pain and shoulder stiffness after about a year trial, other procedures may be tried. These include:

• Steroid injections: More severe pain and swelling may be managed by steroid injections.
  • A corticosteroid, such as cortisone, is injected directly into the shoulder joint.
  • Injecting corticosteroids into your shoulder joint may help decrease pain and improve shoulder mobility, especially in the early stages of the process.
• Joint distension (Hydrodilation). Injecting sterile water into the joint capsule can help stretch the tissue and make it easier to move the joint.
• Manipulation under anesthesia: During this surgery, you will be put to sleep and your doctor will force movement of your shoulder. This will cause the joint capsule to stretch or tear to loosen the tightness. This will lead to an increase in the range of motion.
• Surgery. Surgery for frozen shoulder is rare, but if nothing else has helped, your doctor may recommend surgery to remove tight parts of your joint capsule, scar tissue and adhesions from inside your shoulder joint. Doctors usually perform this surgery with lighted, small pencil sized tubular instruments inserted through small incisions around your joint (arthroscopically)

These last two procedures are often used together to get better results.

Can frozen shoulder be prevented?

The chance of a frozen shoulder can be prevented or at least lessened if physical therapy is started shortly after any shoulder injury in which shoulder movement is painful or difficult. Your orthopaedic doctor or physical therapist can develop an exercise program to meet your specific needs.

What’s the outlook for frozen shoulder?

Simple treatments, such as use of pain relievers and shoulder exercises, in combination with a cortisone injection, are often enough to restore motion and function within a year or less. Even left completely untreated, range of motion and use of the shoulder continue to get better on their own, but often over a slower course of time. Full or nearly full recovery is seen after about two years.