Frozen shoulder is also called adhesive capsulitis because it causes pain and stiffness in the shoulder. It begins with a dull or aching sensation on the upper arm or outer shoulder area, especially when moving the arm. As it progresses, it can make the shoulder very hard to move. It most commonly affects people between the ages of 40 and 60 and occurs more often in women than men. Diabetic patients also have an increased risk of developing frozen shoulder.
Cause of Frozen Shoulder
Research does not indicate a clear cause for frozen shoulder. Diabetes, hypothyroidism, hyperthyroidism, Parkinson’s disease, and cardiac disease may put you more at risk while immobilization due to surgery can also increase developing frozen shoulder.
Frozen shoulder occurs due to a variety of conditions happening within your shoulder: the shoulder capsule thickens; adhesions, which are thick bands of tissue, form; synovial fluid, which helps lubricate the shoulder capsule and joint, decreases. Commonly, three stages develop in frozen shoulder:
- Freezing – Pain progressively increases and range of motion begins to decrease lasting up to 9 months.
- Frozen – Pain may decrease, but stiffness remains restricting daily activities.
- Thawing – Slow improvement of motion. Full recovery from frozen shoulder may take several years. Physical therapy is highly recommended with patients who suffer from frozen shoulder to maintain shoulder flexibility.
Diagram of a normal shoulder.
When Frozen shoulder is diagnozed the Sholder capsule is inflamed.
Dr. Stowell will discuss your symptoms and medical history. He will examine the range of motion in your shoulder. When he performs this test by physically moving your shoulder for you in all directions, it is called “passive range of motion.” He may compare it to your own active range of motion, which is called “active range of motion.” Either displayed passively or actively, frozen shoulder patients show limited range of motion.
Dr. Stowell may request an X-ray, MRI, or ultrasound to rule out other causes of pain and stiffness. If frozen shoulder is diagnosed, you may receive treatment nonsurgically or surgically depending on the severity of your pain after trying more conservative methods of treatment.
Nonsurgical treatments that Dr. Stowell may recommend to treat your pain and restore motion include:
- Non-steroidal anti-inflammatory medication like aspirin or ibuprofen.
- Steroid injections like cortisone injected directly into your shoulder joint.
- Physical Therapy is highly recommended to treat frozen shoulder as it helps restore motion. At-home exercises like passive, external rotational stretching, forward flexional stretching, and crossover arm stretching will likely be recommended.
If nonsurgical treatments do not relieve your symptoms, Dr. Stowell may discuss one of two surgical procedures to treat your frozen shoulder. It is typically offered during the Frozen stage.
- Manipulation under anesthesia. While you are put to sleep, Dr. Stowell will gently move your shoulder. This will stretch or disrupt your shoulder capsule and scar tissue, which will release the tightening and increase your range of motion.
- Shoulder arthroscopy. Dr. Stowell will release tight portions of your joint capsule with small incisions made around your shoulder using a small camera.
- A combination of manipulation under anesthesia and shoulder arthroscopy. In most cases, both of these procedures combined create maximum results.
Recovery after surgery varies from 6 weeks to 3 months and will include physical therapy to maintain motion. Your diligence with therapy is the most important factor in your healing process and the efficiency in returning to normal daily activity. Long-term recovery after surgery is good. Most patients declare no pain or very reduced pain with a much wider range of motion than pre-surgery. In some cases, full motion is not restored and stiffness remains. Patients with diseases like diabetes often have some degree of frozen shoulder post-surgery, and while more uncommon, may have a reoccurrence of frozen shoulder.