Frozen Shoulder

Definition

Frozen shoulder is a tightening of the tissue around the shoulder joint. It results in a loss of movement and pain at the shoulder joint.

In frozen shoulder:

• Active range of motion is lost—You cannot move your shoulder well.
• Passive range of motion is lost—Someone trying to move your arm at the shoulder joint will find it stiff and difficult to move.

This condition may get worse over time. After a period of time, the shoulder may also improve spontaneously. This improvement is called thawing.

Causes

Frozen shoulder is caused by inflammation and scarring of the soft tissues of the shoulder. This includes the capsule that surrounds the joint.

The cause of the tightening is usually not known.

Frozen Shoulder

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Risk Factors

Frozen shoulder is more likely to occur in women between the ages of 40-65 years old.

Factors that increase your risk for frozen shoulder include:

• Diabetes, especially with complex regional pain syndrome
• Thyroid problems
• Disc problems in your neck
• Injuries to the shoulder
• Illness or injury that forces you to keep the shoulder immobile for a period of time
• Coronary artery and/or lung disease, during which time you do not move the shoulder normally

Symptoms

Symptoms include:

• Painful shoulder
• Much reduced movement of the arm at the shoulder joint

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. The range of motion in your shoulder will be tested.

Images may be taken of your shoulder. This can be done with:

• X-rays
• MRI scan
• Arthrogram

Treatment

Treatment focuses on:

• Relieving pain
• Restoring function and range of motion to the shoulder

Nonsurgical Options

• Pain relief with nonsteroidal anti-inflammatory drugs—To help reduce inflammation and relieve pain.
• Muscle relaxants—To help relax arm and shoulder muscles.
• Physical therapy—To stretch muscles and restore motion and function to the shoulder. This is the foundation of treatment. It requires home exercise.
• Heat and ice therapies—To help relieve pain and reduce swelling.
• Corticosteroid injections—As prescribed and given by your doctor (rarely done for this condition).
• Low-level laser therapy and pulsed electromagnetic field therapy—May have some benefit, but evidence is mixed. It may be used alone or with other therapies.
• Extracorporeal shockwave therapy—To stimulate healing using shock waves outside of the body

Surgery

Closed Manipulation

Closed manipulation surgery is a forceful movement of the arm at the shoulder joint. It is done to loosen the stiffness. The surgery is performed under anesthesia. The procedure is followed by intensive physical therapy.

Arthroscopic Surgery

In arthroscopic surgery, a small incision is made in the shoulder. Special small instruments are inserted through the incision. The tightened tissues are released. The shoulder is manipulated. Physical therapy must be done after this procedure.

Capsular Distension

Capsular distension is often done as a combination of an arthrogram and corticosteroid injection. The doctor expands the shoulder joint by injecting salt water under pressure. The fluid may contain cortisone and may also contain a dye that allows the shape and character of the shoulder joint to be seen.

Prevention

Frozen shoulder may recur. To help prevent frozen shoulder:

• Do regular strength training and range-of-motion exercises. This will help maintain a strong and flexible shoulder joint.
• Seek prompt treatment for a shoulder injury.
• Do activities that use your shoulder joint regularly.
• After injury to an upper extremity (such as, hand, wrist, elbow), always move the shoulder through a full range of motion several times a day. This is true even when lying in bed for an illness such as a lung infection.