Frozen Shoulder (adhesive capsulitis of the shoulder)
What is frozen shoulder?
Frozen shoulder is a condition that affects your shoulder joint. It usually involves pain and stiffness that develops gradually, gets worse and then finally goes away. This can take anywhere from a year to 3 years.
Your shoulder is made up of three bones that form a ball-and-socket joint. They are your upper arm (humerus), shoulder blade (scapula), and collarbone (clavicle). There’s also tissue surrounding your shoulder joint that holds everything together. This is called the shoulder capsule.
With frozen shoulder, the capsule becomes so thick and tight that it’s hard to move. Bands of scar tissue form and there’s less of a liquid called synovial fluid to keep the joint lubricated. These things limit motion even more.
What are the symptoms of frozen shoulder?
The typical symptoms are pain, stiffness and limitation in the range of movement of one (not both) of your shoulders. The symptoms typically have three phases:
• Phase one – the ‘freezing’, painful phase. This typically lasts 2-9 months. The first symptom is usually pain. Stiffness and limitation in movement then also gradually build up. The pain is typically worse at night and when you lie on your affected side.
• Phase two – the ‘frozen’, stiff (or adhesive) phase. This typically lasts 4-12 months. Pain gradually eases but stiffness and limitation in movement remain and can become worse. All movements of your shoulder are affected. However, the movement most severely affected is usually rotation of the arm outwards: a bit like the movement you would do if you were holding a tray of food on the palm of your hand, holding it out to the side. The muscles around the shoulder may get smaller as they are not used.
• Phase three – the ‘thawing’, recovery phase. This typically lasts between one and three years. The pain and stiffness gradually go and movement gradually returns to normal, or near normal.
Symptoms often interfere with everyday tasks such as driving, dressing, or sleeping. Even scratching your back, or putting your hand in a rear pocket, may become impossible. Work may be affected in some cases.
There is wide variation in the severity and length of symptoms. Untreated, on average the symptoms last 2-3 years in total before going. In some cases, it is much less than this. In a minority of cases, symptoms last for several years.
Causes
It’s not clear why some people develop it, but some groups are more at risk.
Frozen shoulder happens more often in women than men, and you’re more likely to get it if you’re between the ages of 40 and 60. Your risk might also go up if you’re in the process of recovering from a medical condition like a stroke, or surgery like a mastectomy that keeps you from moving your arm.
Diagnosis
To diagnose frozen shoulder, your doctor will give you a physical exam. They’ll check to see how bad it hurts and how far it moves. During the “active” part of the exam, they’ll let you move your shoulder on your own. During the “passive” portion, they’ll move it for you, and note the differences.
Your doctor may decide you need an injection of anesthetic in your shoulder. This is a medication that will numb the pain so that they can better judge your active and passive ranges of motion.
A physical exam is usually enough to diagnose frozen shoulder, but your doctor may also order imaging tests such as X-rays, ultrasound, or MRI to rule out other problems like arthritis or a torn rotator cuff that can also cause pain and limit how far it moves.
Treatment
Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin or ibuprofen can help relieve the pain and inflammation in your shoulder. If they don’t help, your doctor might prescribe a stronger medication.
Your treatment might also include going to a physical therapist for strengthening and stretching exercises to improve your range of motion.
If your symptoms are intense or don’t improve over time, your doctor might recommend other kinds of treatments, including:
• A corticosteroid injection in your shoulder joint to reduce your pain and improve your range of motion.
• Joint distension. This means your doctor will inject sterile water into your shoulder capsule to stretch it. This can help you move your shoulder more easily.
• Physical therapy. Results with this are mixed, and it may be more useful during certain phases of frozen shoulder than others.
• Surgery. This is very rarely necessary to treat frozen shoulder. But if other treatments haven’t helped, your doctor may suggest surgery. It likely would be an arthroscopic procedure. That means it’s done with lighted, pencil-sized tools that are inserted through tiny cuts in your shoulder.
• Shoulder manipulation can help loosen up your shoulder tissue, but is very rarely done anymore because arthroscopic surgery has replaced it. Surgeons would forcefully move the shoulder under general anesthesia. With this method, there was an increased risk of complications including fractures.