What is frozen shoulder?
Frozen shoulder results from the gradual loss of movement in the shoulder (glenohumeral) joint. This joint consists of a ball (the humeral head) and socket (the glenoid). Normally it is one of the most mobile joints in the body. When the shoulder is frozen, the joint has become stuck and its movement is limited.
What causes frozen shoulder?
Although many shoulder diseases involve pain and loss of motion, frozen shoulder is most often caused by inflammation (swelling, pain and irritation) of the tissues surrounding the joint. The tissue that envelops the joint and holds it together is called the capsule. Normally the capsule has folds that can expand and contract as the arm moves into various positions. In a frozen shoulder, the capsule has become inflamed and scarring develops. The scar formations are called adhesions. As the capsule's folds become scarred and tightened, shoulder movement becomes restricted and moving the joint becomes painful. This condition is called adhesive (scarring) capsulitis (inflammation of the capsule).
It is not known exactly what causes this condition. Immobilization of the shoulder (after an arm injury, for instance) can lead to frozen shoulder. Inflammation of the muscles and/or tendons, as with rotator cuff tendinitis or bursitis, can also cause the shoulder joint to become frozen.
How is frozen shoulder diagnosed?
The first step is to have a complete history and physical examination by your physician. Your physician may order several tests, such as X-rays, to rule out other potential causes of a painful shoulder or limited shoulder motion (arthritis, calcium deposits, etc.).
How is frozen shoulder treated?
The two main goals of treatment are to increase motion and to decrease pain. To increase motion, physical therapy is usually prescribed. The physical therapist moves the patient's arm to stretch the capsule and teaches the patient home exercises that may include use of a wand or overhead pulley. He or she may also use ice, heat, ultrasound or electrical stimulation. The therapist will demonstrate a stretching program that you should do at least once or twice a day. These exercises include the use of a cane, a home pulley system and an elastic cord to increase motion of the shoulder.
To decrease pain, physicians frequently recommend anti-inflammatory medications such as aspirin, ibuprofen (Motrin, Advil), Naprosyn or Aleve. Pain pills such as Tylenol or narcotics may be prescribed to decrease the pain after therapy or to help with sleep at night. Occasionally, steroid injections of the joint or the bursa may be indicated. Steroids like prednisone, taken by mouth, may be given to help decrease the inflammation.
How long does rehabilitation take?
Supervised physical therapy usually lasts from one to six weeks, with the frequency of visits ranging from one to three times per week. The patient should engage in home exercises and stretching throughout the healing process. The stretching exercises should be done at home at least once or twice daily, as noted above. In general, frozen shoulder will resolve almost completely with time and consistent compliance with the prescribed treatment program. This process can take up to six to nine months for some patients, although it may take only a few months for others. Internal rotation (moving the hand to the back pocket or up the middle of your back) is usually the motion that takes the longest to regain.
When is surgery indicated?
If the above program does not improve the range of motion and decrease the pain, then surgery may be indicated. After the patient has had a general or regional anesthetic, the physician may manipulate the shoulder in the operating room to break down the scarring. Occasionally, anarthroscope(a small instrument with an attached camera placed into the shoulder through a small puncture-type incision) is used to directly cut or release the capsular adhesions. Most patients begin physical therapy the same day of the manipulation or the following day.
Other operations, such as the removal of spurs, may also be indicated or required at the time of the manipulation. These operations can sometimes be done with the arthroscope, but may require one or two larger incisions around the shoulder (open surgery).
FAQs
Rotator cuff tears, frozen shoulder, and shoulder impingement are some of the most common conditions that shoulder orthopedic surgeons in Atlanta treat every day. These conditions are commonly confused, especially the frozen shoulder and rotator cuff tear.
Should I force my frozen shoulder to move? ›
Treatment for frozen shoulder. Broadly, treatment works in 3 main steps: Pain relief – avoid movements that cause you pain. Only move your shoulder gently.
What is the fastest way to get rid of a frozen shoulder? ›
Most frozen shoulders get better on their own within 12 to 18 months. For severe or persistent symptoms, other treatments include: Steroid injections. Injecting corticosteroids into the shoulder joint might help decrease pain and improve shoulder mobility, especially if given soon after frozen shoulder begins.
Will my frozen shoulder ever get better? ›
Frozen shoulder usually affects only one shoulder (left or right) and gets better on its own, but it can last two to three years or even longer. People who get frozen shoulder on one side can go on to develop it on the other.
What is the psychosomatic reason for frozen shoulder? ›
Furthermore, It is also hypothesized that some patients develop frozen shoulder due to severe stress causing a psychosomatic reaction, especially if they feel emotionally restricted and pressured, or “frozen” related to the decision-making processes in their day-to-day lives.
What aggravates a frozen shoulder? ›
While keeping your shoulder mobile is vital to healing and recovery, you should still refrain from moving your shoulder in pulling, jerky, and jarring movements. These movements will only make the pain worse and add more strain to your muscles.
What is the new treatment for frozen shoulder? ›
However, many patients do not know that they can now try a minimally invasive alternative treatment for frozen shoulder called adhesive capsulitis embolization (ACE). This procedure has already shown excellent results in successfully relieving capsulitis shoulder pain.
What is the best position to sleep in with a frozen shoulder? ›
Ideally, if you have a frozen shoulder, try to sleep on your back. Sleeping on your back can help take pressure off your shoulder, which may make your pain at night less intense. If you sleep on your back, you might notice better spine alignment, reduced pressure and compression, and improved head, back, and neck pain.
Is heat good for frozen shoulder? ›
Put a heating pad set on low or a warm, wet towel wrapped in plastic on your shoulder. The heat may make it easier to stretch your shoulder. Follow your doctor's advice for stretches and exercises. Go to physiotherapy if your doctor suggests it.
Should you stretch a frozen shoulder? ›
Tissues of a tight shoulder do not like to be stretched suddenly, roughly, or with a lot of force. Thus the strategy is to apply a gentle stretch so that at most minimal soreness results. Any soreness should go away within 15 minutes after you stop the exercises.
In a frozen shoulder, the capsule has become inflamed and scarring develops. The scar formations are called adhesions. As the capsule's folds become scarred and tightened, shoulder movement becomes restricted and moving the joint becomes painful.
What is similar to a frozen shoulder injury? ›
Injury similarities
Degenerative rotator cuff tears and frozen shoulder are most common in adults aged 40 and older. Both these injuries develop gradually, too, which may help explain why many people aren't sure whether their emerging shoulder pain and stiffness is a rotator cuff problem or a joint capsule injury.
How do you rule out a frozen shoulder? ›
To diagnose frozen shoulder, a Penn orthopaedic specialist will evaluate your symptoms and examine your shoulder and arm to assess your range of motion and pain levels. You may require further imaging tests to ensure an accurate diagnosis, such as: CT scan. MRI.
Does frozen shoulder always show up on MRI? ›
While an MRI can potentially show inflammation, it cannot definitively diagnose frozen shoulder. Frozen Shoulder. MedlinePlus website. https://www.nlm.nih.gov/medlineplus/ency/article/000455.htm.
How to differentiate between frozen shoulder and impingement? ›
How Do I Know If I Have Frozen Shoulder or Shoulder Impingement? Frozen shoulder causes a person to not be able to turn their arm out and can be quite painful even when motionless and especially at night. While there is some overlap in symptoms, shoulder impingement is caused by a swollen rotator cuff.
