Frozen shoulder
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Alternative names
Adhesive capsulitis
Definition
Frozen shoulder is the common term for adhesive capsulitis, an inflammatory condition that restricts motion in the shoulder.
Causes, incidence, and risk factors
The capsule of a shoulder joint includes the ligaments that attach the shoulder bones to each other. When inflammation occurs within the capsule, the shoulder bones are unable to freely move within the joint.
Diabetes, shoulder trauma (including surgery), a history of open heart surgery, hyperthyroidism, and a history of cervical disk disease are all associated with an increased risk for this problem. Often, there is no known cause.
Symptoms
Pain and stiffness are the two hallmark symptoms of this disease.
In idiopathic frozen shoulder (i.e., frozen shoulder without an identifiable cause), pain is usually the first symptom, which makes the patient reluctant to move the arm. This lack of movement leads to an involuntary stiffness, which is the second phase of the disease. The third phase, thawing, is a gradual return of motion and function.
Signs and tests
The diagnosis is made primarily by physical exam and the patient’s medical history. There is usually a history of shoulder pain followed by severe stiffness that may not be very painful. If the patient has any history of the risk factors associated with frozen shoulder, these may require treatment as well.
Imaging studies such as x-rays are routine to make sure there is no other problem, such as arthritis. MRI exams may show diffuse inflammation, but there are no findings specific to frozen shoulder.
Treatment
The mainstay of treatment is non-steroidal anti-inflammatory medications (NSAIDs) and physical therapy. While the condition nearly always responds to this intervention, it can take as long as 12-18 months to see improvement. The physical therapy is intense and needs to be performed by the patient on a daily basis at home to be successful.
If therapy is not successful, or if a patient is unable to tolerate therapy, a shoulder manipulation may be performed. Under anesthesia, the shoulder may be forcibly brought through a range of motion to release the scar tissue.
Arthroscopic surgery can be used to cut the tight ligaments and remove the scar tissue from the shoulder. Some surgeons may use repeated pain blocks after surgery to allow the patient to participate in physical therapy after surgery.
Expectations (prognosis)
With therapy and NSAIDs, the problem will usually resolve within a year. When required, surgery is usually successful in restoring motion, but therapy must be continued for several weeks to months after surgery to prevent recurrence. The most common reason for any treatment to fail is non-compliance with therapy.
Complications
Complications include persistent stiffness and pain despite therapy. If there is forceful manipulation of the shoulder during surgery, the arm can break.
Calling your health care provider
If you have shoulder pain and stiffness and suspect you may have a frozen shoulder, contact your health care provider for proper referral and treatment.
Prevention
The best way to prevent frozen shoulder is to contact your health care provider if you develop shoulder pain that limits your range of motion for an extended period of time. This will allow early treatment and help avoid stiffness, if possible.
Diabetic patients should keep tight control of their blood glucose levels. Despite this, they may still develop shoulder stiffness.
by Dave R. Roger, M.D.
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