Frozen shoulder, or adhesive capsulitis, is a condition characterized by ongoing stiffness and pain in the shoulder. Frozen shoulder has no specific cause and is commonly seen in adults (mostly women) between the ages of 40 and 60.
The shoulder is a ball-and-socket joint that is made up of 3 bones: the scapula (shoulder blade), the humerus (upper arm bone), and the clavicle (collarbone). The joint capsule is a watertight sac that encloses the joint and the fluids that lubricate it. The walls of the joint capsule are made up of ligaments. Ligaments are soft connective tissues that attach bones to bones. The joint capsule has a considerable amount of slack, loose tissue, so the shoulder is unrestricted as it moves through its large range of motion.
With a frozen shoulder, inflammation in the joint makes the normally loose parts of the joint capsule stick together. This seriously limits the shoulder's ability to move, causing the shoulder to freeze.
There are 3 distinct stages of frozen shoulder:
- Freezing (painful) stage: In this stage, symptoms progress, pain worsens, and movement becomes very limited. This stage typically lasts 3 to 9 months.
- Frozen (transitional) stage: During this stage, there may actually see some improvement in symptoms. However, the stiffness remains, making daily activities difficult to do. This stage usually lasts 4 to 12 months.
- Thawing stage: There is a gradual return of shoulder mobility in this stage, which can last anywhere from 12 to 42 months.
You can learn more about shoulder anatomy by downloading our educational document A Patient's Guide to Shoulder Anatomy.
Causes of Frozen Shoulder Condition
The cause of frozen shoulder is largely a mystery. One theory is that an overactive immune response or an autoimmune reaction may be at fault. In an autoimmune reaction, the body's defense system, which normally protects it from infection, mistakenly begins to attack the tissues of the body. This causes an intense inflammatory reaction in the tissue that is under attack. People with diabetes or thyroid dysfunction, as well as anyone who has had a heart attack, stroke, or been treated for breast cancer is also at increased risk for this condition. But a significant number of people develop adhesive capsulitis without any known trauma, medical history, or other risk factor.
No one knows why this occurs so suddenly. Pain and stiffness may begin after a shoulder injury, fracture, or surgery. It can also start if the shoulder is not being used normally. This can happen after a wrist fracture, when the arm is kept in a sling for several weeks. For some reason, immobilizing a joint after an injury seems to trigger the autoimmune response in some people.
Orthopedic specialists theorize that the underlying condition may cause chronic inflammation and pain causes you to use that shoulder less often. This sets up a situation that can create adhesive capsulitis. In many cases, it may be necessary to treat the shoulder first in order to regain its ability to move before the underlying problem can be addressed.
Symptoms of Frozen Shoulder Condition
The symptoms of adhesive capsulitis (and frozen shoulder) are primarily shoulder pain and stiffness, resulting in a very reduced range of shoulder motion. The tightness in the shoulder can make it difficult to do regular activities like getting dressed, combing your hair, or reaching across a table.
Frozen Shoulder Diagnosis
The diagnosis of frozen shoulder is usually made on the basis of your medical history and a physical examination. One key finding that helps differentiate a frozen shoulder from other shoulder conditions is how the shoulder moves. With frozen shoulder, the patient has limited range of motion both actively (moving it on your own) and passively (the doctor moving it for you).
Imaging tests may also be needed in order to make a full diagnosis. The most common test used is magnetic resonance imaging (MRI). An MRI scan is a special imaging test that uses magnetic waves to create a series of pictures, called slices, that show the tissues of the shoulder. The MRI scan shows tendons and other soft tissues as well as the bones.
Nonsurgical treatment frozen shoulder options
The goal of initial treatment is to reduce the inflammation and increase the range of motion in the shoulder and many people respond with relatively simple treatments. Your doctor may recommend anti-inflammatory medications, such as ibuprofen, or cortisone injections and a long-acting anesthetic, similar to lidocaine.
Physical or occupational therapy treatments may also be recommended because they are a critical part of helping you regain the motion and function of your shoulder. Treatments are directed at getting the muscles to relax. Therapists use heat and hands-on treatments to stretch the joint capsule and muscle tissues of the shoulder. You will also be given exercises and stretches to do as part of a home program. You may need therapy treatments for three to four months before you get full shoulder motion and function back.
Surgery for Frozen Shoulder
If progress in rehabilitation is slow, your doctor may recommend surgery. The goal of surgery is to stretch and release the stiffened joint capsule. The most common methods include manipulation under anesthesia and shoulder arthroscopy.
Manipulation under Anesthesia
During this procedure, you are put to sleep so the orthopedic surgeon can aggressively stretch your shoulder joint. The heavy action of the manipulation stretches the shoulder joint capsule and breaks up the scar tissue. In most cases, the manipulation improves motion in the joint faster than allowing nature to take its course. You may need this procedure more than once.
This procedure has risks. There is a very slight chance the stretching can injure the nerves of the brachial plexus, the network of nerves running to your arm. And there is a risk of fracturing the humerus (the bone of the upper arm), especially in people who have osteoporosis (fragile bones).
When it becomes clear that physical therapy and manipulation under anesthesia have not improved shoulder motion, arthroscopic release may be needed. This procedure is usually done using an anesthesia block to deaden the arm. The surgeon uses an arthroscope to see inside the shoulder. An arthroscope is a slender tube with a camera attached. It allows the surgeon to see inside the joint.
During the arthroscopic procedure, the surgeon cuts (releases) scar tissue, the ligament on top of the shoulder (coracohumeral ligament), and a small portion of the joint capsule. At the end of the release procedure, the surgeon gently manipulates the shoulder to gain additional motion. A steroid medicine may be injected into the shoulder joint at the completion of the procedure.
Our orthopedic experts will talk with you about your treatment options. You can also learn more about shoulder arthroscopy by downloading our educational document A Patient’s Guide to Shoulder Arthroscopy.
Rehabilitation Following Frozen Shoulder Surgery
The primary goal of rehabilitation is to regain full range of motion in the shoulder. This is done with physical therapy.
Our orthopedic specialists and physical therapy team will work together to create a rehabilitation plan that is designed specifically for you to gain back your strength and range of motion, as much as possible. Depending on the type of treatment you received, recovery times can range anywhere from 6 weeks to 3 months.
To speak with an SROSM shoulder specialist, make an appointment at the location closest to you in Spring or The Woodlands. You can also learn more about frozen shoulder by downloading our educational document A Patient’s Guide to Adhesive Capsulitis.