What Is Frozen Shoulder?
Frozen shoulder, also known as adhesive capsulitis, is a shoulder condition that causes pain and limits range of motion. It is a cyclical condition that gradually worsens and gradually improves and is fairly common, especially for those in their 30s,40s and 50s. It can oftentimes take up to 2 years to resolve on its own
The shoulder is lined by a capsule of tough connective tissue that houses some of the muscles, ligaments and tendons, along with synovial fluid that helps lubricate the joint. This capsule can thicken and inflame, causing pain and a reduction in the shoulder’s range of motion. Patients will often complain that their pain is worse when they try to sleep.
Causes and Risk Factors
The cause of frozen shoulder is unknown, but there are a number of risk factors. These include:
- Being female
- Being over age 40
- Heart disease
- Immobilization of an arm for a long period, such as after a fracture
- Parkinson’s disease
- Thyroid disorders
- High cholesterol
- Family history of diabetes
Pain and limited range of motion are the main symptoms of frozen shoulder. Range of motion is limited both passively (when someone else tries to move the person’s arm) and actively (when the person tries to move his or her own arm).
Frozen shoulder has three stages, each lasting for a number of months:
- Inflammatory or “freezing” stage: In this stage, pain develops and gets worse, and range of motion begins to become restricted.
- Frozen stage: Pain may improve during this stage, but the range of motion becomes even more limited. Even simple daily activities may become difficult to perform.
- Thawing stage: Range of motion begins to improve.
Cycling through these stages may take roughly anywhere from one to four years, from the gradual onset of pain until the resolution and full return of range of motion. Men and patients with diabetes or thyroid disorders are more likely to have a longer, more arduous course.
Often, a physical examination and medical history are enough to determine the presence of frozen shoulder. Doctors will move the arm in different directions (passive range of motion) and compare the range of motion to when the patient moves his or her own arm (active range of motion). Range of motion will be restricted in both cases.
Imaging studies, such as X-rays, magnetic resonance imaging (MRI) or ultrasound, can be useful in ruling out other causes of shoulder pain but are often normal in patients with adhesive capsulitis.
Frozen shoulder will improve on its own without treatment in the majority of cases. However, recovery can be a slow process, and patients may seek treatment to speed it along, to manage the pain or to improve range of motion. In some cases, range of motion does not fully return even if the condition resolves itself.
Treatment can include one or more of:
- Frozen shoulder exercises and physical therapy: These exercises focus on capsular stretching and regaining range of motion, not strengthening.
- Over-the-counter (OTC) medications: To treat symptoms, OTC medications such as painkillers and anti-inflammatories may be recommended.
- Steroid injections: To relieve some of the pain and inflammation, steroids may be suggested.
- Release surgery: This arthroscopic surgery involves cutting the tight parts of the shoulder capsule to improve range of motion.Surgery is offered if patients do not respond to nonsurgical treatment options.
If you suspect you have frozen shoulder, schedule an appointment with one of our shoulder and elbow specialists to discuss your treatment options.