Frozen shoulder

Adhesive capsulitis

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.

The main symptoms are pain and stiffness.

In those with idiopathic frozen shoulder (frozen shoulder without an identifiable cause), pain is usually the first symptom. The patient usually does not want to move the arm. The lack of movement leads to stiffness, which is the second phase of the disease. The third phase, thawing, is when the motion and function of the shoulder slowly returns.

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, which 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 widespread inflammation, but there are no findings specific to frozen shoulder.

Treatment involves non-steroidal anti-inflammatory medications (NSAIDs), steroid injections, and physical therapy. It can take as long as 12-18 months to see improvement. The physical therapy is intense and needs to be done every day. Steroid injections can significantly improve the results of physical therapy.

If therapy is not successful, or if a patient can not tolerate therapy, a shoulder manipulation may be performed. This procedure is done under anesthesia. The health care provider will forcibly bring the shoulder 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 so the patient can participate in physical therapy after surgery.

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 include persistent stiffness and pain despite therapy. If there is forceful manipulation of the shoulder during surgery, the arm can break.

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.

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.

Patients with diabetes should keep tight control of their blood glucose levels.

Sheridan MA, Hannafin JA. Upper extremity: emphasis on frozen shoulder. Orthop Clin North Am. 2006 Oct;37(4):531-9. Review.

Brue S, Valentin A, Forssblad M, Werner S, Mikkelsen C, Cerulli G. Idiopathic adhesive capsulitis of the shoulder: a review. Knee Surg Sports Traumatol Arthrosc. 2007 Feb 28; [Epub ahead of print].