Description

Frozen shoulder (adhesive capsulitis) is a disorder characterized by pain and loss of motion or stiffness in the shoulder. It affects about two percent of the general population. It is more common in women between the ages of 40 years to 70 years old but can occur in men as well. The causes of frozen shoulder are not fully understood. The process involves thickening and contracture of the capsule surrounding the shoulder joint. Dr. Brady can diagnose frozen shoulder based on the history of the patient's symptoms and physical examination. X-rays or MRI (magnetic resonance imaging) studies are sometimes used to rule out other causes of shoulder stiffness and pain, such as rotator cuff tear.

Frozen shoulder occurs much more commonly in individuals with diabetes, affecting 10 percent to 20 percent of these individuals. Other medical problems associated with increased risk of frozen shoulder include: hypothyroidism, hyperthyroidism, Parkinson's disease, and cardiac disease or surgery. Frozen shoulder can develop after a shoulder is injured or immobilized for a period of time. Attempts to prevent frozen shoulder include early motion of the shoulder after it has been injured.

Symptoms

Pain due to frozen shoulder is usually dull or aching but sometimes can be quite severe. It can be worsened with attempted motion. The pain is usually located over the outer shoulder area and sometimes the upper arm. The hallmark of the disorder is restricted motion or stiffness in the shoulder. The affected individual cannot move the shoulder normally. Motion is also limited when someone else attempts to move the shoulder. Some physicians have described the normal course of a frozen shoulder as having three stages:

Treatment Options

Frozen shoulder will generally get better on its own. However, this takes some time, occasionally up to two to three years. If you have a stiff and painful shoulder, see your physician to make sure no other injuries are present.

Dr. Brady’s treatment goal is to shorten the recovery time therefore pain control and restoration of motion are essential. Usually this begins with a cortisone injection (for pain relief) followed by aggressive physical therapy. Over 90% of patients can overcome this problem with a series of three injections (at monthly intervals) and physical therapy. Examples of some of the exercises that might be recommended can be seen in figures 1, 2, and 3.

Treatment Options: Surgical

Unfortunately a small percentage of people (particularly diabetics) are resistant to these conservative strategies. In these cases Dr. Brady usually offers arthroscopic surgery as an option. During this procedure Dr. Brady releases the scar tissue in your shoulder through the arthroscope. He then manipulates your arm to regain all of your motion. Following surgery he injects a corticosteroid and a numbing medicine and then you start aggressive physical therapy the next day for several weeks. This technique is successful in over 90% of cases.

Research on the Horizon/What's New?

Although several theories exist, the cause of frozen shoulder is not known. Further research is needed to determine its exact cause. If the cause could be determined, better preventative measures or treatments could be developed. Most patients affected by frozen shoulder do get better with time. Many surgeons have reported the results of various physical therapy regimes as well as surgery. Further research could help determine which treatments work best, or if treatment changes the normal course of the disease.