Frozen shoulder, which is also known as adhesive capsulitis, involves painful loss of range of motion in the affected shoulder. It can affect any adult, but is most common in women in their 40’s and 50’s. Although many patients recall some sort of fall or a minor trauma to the shoulder when the frozen shoulder began, there is frequently no identifiable cause.
Understanding the anatomy of the shoulder is important to understand the process of a frozen shoulder. Your shoulder has a capsule around it which helps to keep the ball located within the socket correctly. When you develop a frozen shoulder, that capsule becomes thick and tight. That limits your motion. It can also occur after a surgery or a fracture when there may be a period of immobilization and scarring of the shoulder.
Typically, there is a “freezing” phase where the patient is initially painful with good motion, and then progressively becomes more and more stiff. This is followed by improvement in the pain, but the shoulder remains stiff. Finally, the shoulder “thaws” and the motion returns. Altogether, the average length of time from start to finish is 18 months. For some people, it can be shorter, and for some, it can be even longer. Although it can be quite painful, limiting, and frustrating to deal with this problem for so long, only a small minority of patients with a frozen shoulder end up needing surgery. Most are successfully treated with conservative treatments such as steroid injections, anti-inflammatory medications, and physical therapy.
Most patients with a frozen shoulder do not have associated tendon tears in their shoulder, such as in the rotator cuff. X-rays of the shoulder are frequently normal. Diagnosis is mostly based on physical exam and history, so unless your doctor suspects there is something additional going on, you most likely will not need an MRI to diagnose the frozen shoulder.
Certain types of medical problems can increase the risk of having a frozen shoulder, as well as sometimes making it more difficult to treat. “Endocrinopathies”, a class of conditions which involve problems with regulation of various hormones in your body, are the most common associations. This class includes diabetes and high or low thyroid, for example. Therefore, if you don’t have any history of one of these endocrinopathies, your doctor may order some lab work to check for those conditions. If found, they are usually treated by your primary care physician, but occasional difficult cases may require a specialist called an endocrinologist. Treating an underlying condition such as diabetes can improve the course of the frozen shoulder.
As mentioned above, surgery is usually not required. However, a small portion of patients who do not improve with conservative treatment will require surgery. This consists of an outpatient arthroscopic surgery (the cameras with the small incisions) with release of the capsule. If there are tears or additional problems, they can be addressed at the same time. Once the scarred thickened capsule is cut to allow more mobility, the shoulder is taken through a range of motion while the patient is anesthetized and motion is not limited by pain. Postoperatively, range of motion with physical therapy, and sometimes a special chair, is started right away to prevent it from freezing again.
If you have been dealing with a frozen shoulder that won’t seem to thaw, it’s a good idea to have your shoulder checked out by a shoulder specialist. Contact our office today to schedule an appointment.