What is frozen shoulder?

A frozen shoulder occurs when the shoulder capsule becomes thick and difficult to move. The shoulder capsule is tissue that surrounds the shoulder joint that holds the humerus (upper arm), scapula (shoulder blade) and clavicle (collarbone) together.
When you have frozen shoulder, bands of scar tissue can form and there is less synovial fluid to help lubricate the joint. The name “frozen” comes from the fact that the shoulder is hard to move and is “frozen” in place.

Stages of frozen shoulder

  • Freezing — you gradually experience more pain, and you lose the ability to fully move your shoulder, can take anywhere from six weeks to nine months.
  • Frozen — symptoms often improve in this stage, but day-to-day activities are challenging, can last for four to six months.
  • Thawing — the motion in your shoulder gradually improves during the thawing stage, can take as long as two years to return to full activity.

Causes of frozen shoulder

The cause of frozen shoulder is not clear, but it happens when scar tissue forms in the shoulder. When scar tissue builds up, the shoulder capsule thickens and tightens, which leaves less room for movement.

Risk factors for frozen shoulder

  • Sex — more women than men are affected by frozen shoulder.
  • Age — frozen shoulder typically affects people between the age of 40 and 60.
  • Diabetes — frozen shoulder is more prevalent in people with diabetes, 10 - 20% of patients with diabetes develop frozen shoulder.
  • Immobilization — patients who have been required to immobilize their shoulder due to other conditions, surgery or injuries may be at higher risk for developing a frozen shoulder.
  • People who have conditions such as hypothyroidism, hyperthyroidism, cardiac disease and Parkinson’s disease are at higher risk for developing a frozen shoulder.

Symptoms of frozen shoulder

Dull, achy pain and inability to move the arm are the most common symptoms of a frozen shoulder. The pain typically is concentrated over the outer shoulder area or the upper arm.

Diagnosis of frozen shoulder

A frozen shoulder can be diagnosed in a full physical exam with your doctor.

Your physician will take your full medical history to determine what your symptoms are, what makes them worse and if there was a significant event that led to your symptoms.

Your doctor will do tests to determine what your range of motion is as well as what positions the pain in the shoulder is the most severe. He or she will ask you to move your shoulder and he or she will move your shoulder to determine if your shoulder has different range of motion based on who is moving it. If you have frozen shoulder, the range of motion will be limited in both capacities.

In many cases, your doctor will order imaging tests to rule out other causes of pain including:

  • X-ray — shows abnormalities in the bones in the shoulder.
  • Magnetic resonance imaging (MRI) —  can show abnormalities in the soft tissues.
  • Ultrasound — can also show problems in the soft tissues.

Treatment of frozen shoulder

Most patients will be able to fully recover from frozen shoulder with nonsurgical treatments.

Nonsurgical treatment options 

Early nonsurgical treatment options for frozen shoulder include:

  • Non-steroidal anti-inflammatory medications — can reduce the swelling and pain associated with frozen shoulder.
  • Steroid injection — cortisone can be injected directly into the shoulder joint to help relieve pain. 
  • Physical therapy and rehabilitation — physical therapy will be required to help restore function to the shoulder, will most likely include stretching and range of motion exercises for the shoulder.

Surgical treatment options
If your symptoms are not getting better with nonsurgical therapies, your doctor may recommend surgery to repair your frozen shoulder. The primary goal of surgery is to release the stiffened joint capsule.  
Surgical treatment options include:

  • Arthroscopic capsule release surgery — your physician will cut through the stiff areas in the joint capsule using small incisions, a camera and tiny surgical instruments. 
  • Manipulation under anesthesia — in some cases, your doctor may put you under anesthesia before or after arthroscopy and manipulate the shoulder by forcing your shoulder to move. 

Together, capsule release surgery and manipulation can provide the greatest chance for successful results.

Recovery from frozen shoulder

Recovery from frozen shoulder, with or without surgery, can take as long as three years. Physical therapy is imperative to aid in maintaining the range of motion achieved with surgery or nonsurgical treatments. Dedication to your rehabilitation program is the most important factor in getting you back to your normal shoulder function.

Frozen shoulder can recur if risk factors are still present.

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