Frozen shoulder, or adhesive capsulitis, is a condition which causes pain and stiffness in the shoulder joint that gradually worsens over time, making it very difficult to move the shoulder. The soft tissue surrounding the shoulder joint thickens, and this inflammation can cause scarring. The build-up of scar tissue restricts movement inside the joint, resulting in pain and severely limiting motion. Frozen shoulder can be classified into 2 types, primary and secondary.
Orthopedic and Sports Medicine Institute (OSMI) is an orthopedic surgery and sports medicine practice located in Fort Worth Texas. Dr. Boothby and Dr. Beavers are orthopedic surgeons who treat shoulder injuries and disorders like frozen shoulder (adhesive capsulitis).
What is Frozen Shoulder?
Frozen shoulder is the common name for a condition adhesive capsulitis. The condition causes pain and stiffness in the shoulder and over time, the shoulder becomes very hard to move.
When frozen shoulder is present, the shoulder capsule (the soft tissue surrounding the shoulder joint) thickens and becomes tight. This inflammation causes scarring, which results in adhesions (scar tissue). The build-up of scar tissue restricts movement inside the joint—resulting in pain and severely limited motion.
Causes of Frozen Shoulder
This is a tricky question because the cause of frozen shoulder is poorly understood. There are two types of frozen shoulder: primary and secondary.
The cause of primary frozen shoulder is unknown. Researchers have speculated that it could be caused by changes in the immune system or hormonal imbalances, but as of yet there is no data to prove or disprove this. Some conditions appear to be contributing—or perhaps just co-occurring—factors: diabetes, hypothyroidism, hyperthyroidism, Parkinson’s disease, and cardiovascular disease. Frozen shoulder occurs more frequently in people with diabetes—about 10 to 20 percent of people with diabetes are affected by it.
The condition is classified as secondary frozen shoulder when it develops as a result of a known cause. These can include:
- Prolonged immobilization
- Stiffness following a shoulder injury
- Fracture
- Surgery
Conditions which seem to be contributing factors for frozen shoulder or which co-occur with frozen shoulder are:
- Diabetes: 10-20% of diabetics are affected.
- Hypothyroidism
- Hyperthyroidism
- Parkinson’s disease
- Cardiovascular disease
- Tuberculosis
- Secondary frozen shoulder can develop as a result of:
- Prolonged immobilization
- Stiffness after shoulder injury
- Fracture
- Surgery
Symptoms and Stages of Frozen Shoulder
Frozen shoulder usually develops gradually in stages which may last several months. Symptoms include:
- Dull, aching pain over the outer shoulder and sometimes the arm.
- Loss of motion.
- Complete inability to move the shoulder.
Stages of frozen shoulder and their approximate durations are:
- Freezing stage (6 weeks -9 months): Any shoulder movement causes pain which increases over time until range of motion becomes limited.
- Frozen stage (4-6 months): Pain may diminish, however, loss of motion remains. Daily activities become more difficult due to lack of shoulder mobility.
- Thawing stage (6 months-2 years): Shoulder motion slowly improves.
Diagnosing a Frozen Shoulder
Frozen shoulder, or adhesive capsulitis, is a condition which causes pain and stiffness in the shoulder joint that gradually worsens over time, making it very difficult to move the shoulder.
Diagnosing frozen shoulder will involve a physical examination in which your doctor evaluates your passive range of motion (someone else moves your arm) and your active range of motion (you move your own arm). A numbing medicine may be used to help determine range of motion.
While frozen shoulder can typically be diagnosed from this exam, your doctor may recommend imaging tests, such as an x-ray or MRI, to rule out the possibility of other causes for the pain and stiffness.
Treatment for Frozen Shoulder
Frozen shoulder typically improves over time—but the process can take as long as three years. The focus of treatment is to control pain and restore range of motion.
Treatment for frozen shoulder involves pain management and restoration of range of motion. Non-surgical treatments include:
- Medication: NSAIDs or prescription pain relievers and anti-inflammatories.
- Physical therapy: Range-of-motion exercises and stretching to restore mobility. Heat may be used in conjunction with therapy to loosen up the shoulder.
- Steroid injections: Corticosteroid, a powerful, anti-inflammatory agent is injected directly into the joint.
- Surgical treatments may be necessary in some frozen shoulder cases, when non-surgical techniques fail to relieve symptoms. Common procedures include:
- Shoulder manipulation: Performed under general anesthesia, your doctor manipulates the shoulder in different directions, which allows the scar tissue to stretch and tear. This loosening of the tissue can increase range of motion.
- Shoulder arthroscopy: Minimally invasive procedure in which a fiber optic camera and lighted tubular instruments are used to cut through tight portions of the joint capsule restoring range of motion.
- Manipulation Under Anesthesia: While you sleep under general anesthesia, your doctor will force—or manipulate—your shoulder to move. This causes the scar tissue to stretch or tear and can increase range of motion.
- Sometimes, manipulation and arthroscopy are used together to produce maximum results.
Recovery
Recovery from frozen shoulder varies. With nonsurgical treatment, recovery can take anywhere from one to three years. Recovery from surgical treatment takes anywhere from six weeks to three months.
A commitment to physical therapy and stretching will help ensure good results.
Our goal at OSMI is to provide our patients quality, cutting-edge orthopedic treatments, both surgical and nonsurgical. If you have questions about a frozen shoulder (adhesive capsulitis), shoulder joint pain, or physical therapy for frozen shoulder, please submit an online appointment request or contact our office at 817-529-1900.
