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Frozen Shoulder

Frozen shoulder or adhesive capsulitis is a condition that causes pain and stiffness in the shoulder joint.  The shoulder is a ball-and-socket joint where the ball (humerus) is attached to the socket (scapula) by many soft tissues surrounding it including a joint capsule and ligaments.  If you have adhesive capsulitis, the joint capsule surrounding the shoulder joint becomes thick and fibrous resulting in a significant reduction in motion.  


There are three phases associated with adhesive capsulitis: freezing, frozen and thawing.  In a “freezing” shoulder, the capsule is slowly becoming tighter and gradually causes more pain.  Your motion may also decrease throughout this stage which may last between six weeks to nine months.  In a “frozen” shoulder, pain may not be as much of an issue, but motion will be significantly limited.  This stage can last between four to six months.  Finally, a “thawing” shoulder is one that has been “frozen” but motion is gradually being restored.  The entire process is long and frozen shoulder can take up to two to three years to resolve.

 

Although the exact cause of this shoulder pathology is unknown, there are several risk factors associated with adhesive capsulitis.  It generally occurs in patients between the ages of 40-60 and often affects women more than men.  Diabetes, Parkinson’s disease, hypothyroidism, hyperthyroidism and cardiac disease places a patient at greater risk of developing adhesive capsulitis.  Additionally, any type of shoulder immobilization can place a patient at a greater risk.

 

Treatment for a frozen shoulder is conservative and generally consists of non-steroidal anti-inflammatories (ibuprofen, aspirin), rehabilitation and sometimes a cortisone injection.  Most patients’ symptoms improve with this type of treatment and do not require further intervention.  However, if conservative management fails, surgical intervention may be warranted.  This can consist of a manipulation under anesthesia or arthroscopic surgery to cut the thick joint capsule.  Although surgery can help stretch or break up the scar tissue, proper rehabilitation will be required to maintain the gains achieved by the surgery.  Your doctor can discuss these different options with you and help choose what is right for you.