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Frozen Shoulder

Frozen shoulder is a condition of stiffness and pain in the shoulder that limits normal movement of the joint. It is also known as adhesive capsulitis.

The shoulder has two joints. The glenohumeral joint is a highly flexible ball-and-socket joint, formed by the connection of the humerus (upper arm) and the scapula (shoulder blade). The upper end of the humerus has a rounded shape that fits into a shallow concavity of the scapula called the glenoid fossa. There is a strong capsule of connective tissue that surrounds the joint, partially formed from ligaments. Contained within the capsule is synovial fluid, a nourishing and lubricating substance. If the capsule becomes too tight, the range of motion of the shoulder is restricted, causing pain and immobility.

The second shoulder joint is the acromioclavicular joint, formed by the connection of a different part of the scapula, the acromion, and the clavicle (collarbone). Both joints need to be working properly for full motion of the shoulder, although the glenohumeral joint is responsible for most movement.

Frozen shoulder happens when the shoulder capsule becomes thicker. Bands of stiff tissue called adhesions form, causing the capsule to tighten up. The condition develops gradually. In the beginning stages, pain slowly increases and the range of motion of the shoulder decreases. This stage can last anywhere from six weeks to nine months.

The second stage is the classic ‘frozen shoulder’ stage. The pain may diminish at this time, although the stiffness in the joint continues to develop and the resultant loss of range of motion may cause difficulties in performing daily activities.

Gradually, over the course of up to two or three years, full motion and strength returns to the joint.

It is not completely understood what causes a frozen shoulder. What is clear is that there are factors that increase the risk of developing the condition. People with diabetes are much more likely to suffer from a frozen shoulder, as are people with other medical conditions such as Parkinson’s disease, cardiovascular disease, tuberculosis, and thyroid disorders.

A frozen shoulder can also develop as a result of immobilization of the joint, for example after an injury or surgery. For this reason, patients are encouraged to begin moving their shoulders soon after a medical procedure.

Women, and people over the age of 40, are more likely to develop a frozen shoulder.

  • Frozen shoulder pain is typically described as ‘dull’ or ‘achy’. It is felt over the outer area of the shoulder and sometimes in the upper arm. Movement makes the pain worse.
  • Movement of the shoulder becomes increasingly difficult due to stiffness and pain.
  • Some people experience more pain at night.
Your doctor will ask you questions about the duration and severity of your symptoms. You will have a physical examination, during which time the range of motion of your arm and shoulder will be carefully tested. Your doctor will move your shoulder around to assess the passive range of motion, and you will be asked to move the shoulder by yourself so that active range of motion can also be determined. A frozen shoulder usually limits both passive and active range of motion.

X-rays may be taken, primarily to rule out other conditions such as arthritis. Ultrasound or MRI (magnetic resonance imaging) scans may also be done to view the soft tissues of the joint.

Treatment of a frozen shoulder is designed to restore movement to the shoulder, and reduce pain. Over 90% of sufferers improve with simple treatment.

To reduce pain and swelling, your doctor will probably prescribe NSAIDs (non-steroidal anti-inflammatory drugs). Examples of such drugs are Advil, Motrin and Aleve. Sometimes you may be prescribed stronger pain and anti-inflammatory medication.

You may also receive a corticosteroid injection directly into the shoulder joint, which will normally provide rapid relief from pain and inflammation. Such injections are highly effective but, due to possible side effects, cannot be repeated more than two or three times a year.

Physical therapy, possibly under the supervision of a physical therapist, will include exercises to gradually stretch the muscles around the joint and improve range of motion. Sometimes heat is applied to the shoulder before beginning treatment.

Very occasionally, if conservative treatment has not provided relief, surgery is performed. Under anesthetic, the surgeon might stretch or tear the capsule and adhesions by forcibly manipulating the shoulder in order to release the tightness. Another procedure is to cut through the tight areas, using thin instruments inserted through tiny incisions around the shoulder area. Results from surgical intervention are normally very successful.

It is extremely important to try to maintain and increase the range of motion of the shoulder. Exercising several times daily is necessary. Pain felt while doing exercises should not be worse than mild. Stop exercising and consult your doctor if you feel a sharp or tearing pain.

Standing or sitting, let your arm hang down at your side. Allow your arm to swing from side to side and back and forth, then in small circles. Keep the distances short. Repeat this exercise for 3-7 days then add a small weight (1-2 lbs). Gradually increase the range of motion.
Passive stretches:
These are best performed after the above pendulum exercise. Do 2 sets of 10-20 repetitions twice each day and do not stretch to the point of pain, only tension.
Armpit stretch:
Lift the arm of the affected side onto a surface that is about chest-high. Slowly bend your knees so that your armpit gradually opens. Increase the bend as the shoulder loosens.
Wall walking:
Standing and facing a wall that is about three-quarters of your arm’s length away, walk your fingers up the wall until your arm is at shoulder level. Do not use your shoulder muscles to achieve this - just your fingers.
Towel stretch:
Hold a towel behind your back in both hands. Use the unaffected arm to pull on the towel so that the affected arm moves across your back.
Place the affected arm on the other, unaffected, shoulder. Rotate the elbow of the affected side in very small circles, increasing the range as the shoulder loosens and discomfort allows.

In most cases, a frozen shoulder resolves itself, but it may take up to three years for full mobility to be restored and occasionally a small amount of stiffness remains. Exercising the shoulder regularly will be greatly beneficial.