Dr. Mazzara sees many patients daily with a certain degree of stiffness of the joint contributing to their shoulder pain. Sometimes the loss of motion is obvious and dramatic and sometimes it is very subtle and only noted when we compare the other shoulder. Below is some educational information from the AAOS that Dr. Mazzara found very helpful for patients with Frozen Shoulder.
What is Frozen Shoulder (adhesive capsulitis)?
Frozen shoulder, or adhesive capsulitis, causes pain and stiffness in the shoulder that becomes harder to move over time. About 2% of people will develop frozen shoulder and it mainly affects women ages 40-60.
What are the different parts of my shoulder?
Your shoulder is a ball-and-socket joint made up of three bones:
- upper arm bone (humerus)
- shoulder blade (scapula)
- collarbone (clavicle)
The head of the humerus fits into a shallow socket in scapula. Strong connective tissue, called the shoulder capsule, surrounds the joint. Your shoulder moves easier with a synovial fluid which lubricates the shoulder capsule and the joint.
What are the stages of Frozen Shoulder?
In frozen shoulder, the shoulder capsule thickens and becomes tight and adhesions develop. Often, there is less synovial fluid surrounding the joint. A sign of this condition is being unable to move your shoulder either by yourself or with help. Frozen shoulder develops in three stages:
- Freezing- In the “freezing” stage, you slowly have more and more pain. As the pain worsens, your shoulder loses range of motion. Freezing typically lasts from 6 weeks to 9 months.
- Frozen- Your shoulder will be stiff however the painful symptoms may actually improve. The “frozen” stage last about 4-6 months and daily activities may be difficult.
- Thawing- During the “thawing” stage, shoulder motion slowly improves. Complete return to normal or close to normal strength and motion typically takes from 6 months to 2 years.
What causes Frozen Shoulder?
The main cause of Frozen Shoulder is still unknown. There are a few factors which may increase your risk for developing Frozen Shoulder. Some of the factors are:
- Other diseases- hypothyroidism, hyperthyroidism, Parkinson’s disease, and cardiac disease
What are the symptoms of Frozen Shoulder?
The pain from Frozen Shoulder is felt in the outer shoulder area or the upper arm. It is a dull aching pain typically worse in the beginning and when you move your arm.
How is Frozen Shoulder diagnosed?
Your doctor will discuss your symptoms and medical history and then examine your shoulder. Your doctor will move your shoulder carefully in all directions to see if movement is limited and if pain occurs with the motion. The range of motion when someone else moves your shoulder is called “passive range of motion.” Your doctor will compare this to the range of motion you display when you move your shoulder on your own (“active range of motion”). People with frozen shoulder have limited range of motion both actively and passively.
Other tests that may help your doctor rule out other causes of stiffness and pain include:
- X-rays- Dense structures, such as bone, show up clearly on x-rays. X-rays may show other problems in your shoulder, such as arthritis.
- Magnetic resonance imaging (MRI) and ultrasound- These studies can create better images of problems with soft tissues, such as a torn rotator cuff.
How is Frozen Shoulder treated?
Typically, Frozen Shoulder will resolve in about 3 years. The focus of treatment is to control pain and restore motion and strength through physical therapy.
More than 90% of patients improve with relatively simple treatments to control pain and restore motion.
- Non-steroidal anti-inflammatory medicines. Drugs like aspirin and ibuprofen reduce pain and swelling.
- Steroid injections- Cortisone is a powerful anti-inflammatory medicine that is injected directly into your shoulder joint.
- Physical therapy- Specific exercises will help restore motion. These may be under the supervision of a physical therapist or via a home program. Therapy includes stretching or range of motion exercises for the shoulder. Sometimes heat is used to help loosen the shoulder up before the stretching exercises. Below are examples of some of the exercises that might be recommended.
- External rotation (passive stretch)- Stand in a doorway and bend your affected arm 90 degrees to reach the doorjamb. Keep your hand in place and rotate your body as shown in the illustration. Hold for 30 seconds. Relax and repeat.
- Forward flexion (supine position)- Lie on your back with your legs straight. Use your unaffected arm to lift your affected arm overhead until you feel a gentle stretch. Hold for 15 seconds and slowly lower to start position. Relax and repeat.
- Crossover arm stretch- Gently pull one arm across your chest just below your chin as far as possible without causing pain. Hold for 30 seconds. Relax and repeat.
Surgery may be an option is the Nonsurgical Treatments do not work. Frozen Shoulder surgery stretched and releases the stiffened joint capsule. The most common methods include manipulation under anesthesia and shoulder arthroscopy.
- Manipulation under anesthesia- During this procedure, you are put to sleep. Your doctor will force your shoulder to move which causes the capsule and scar tissue to stretch or tear. This releases the tightening and increases range of motion.
- Shoulder arthroscopy- In this procedure, your doctor will cut the tight portions of the joint capsule. This is done using pencil-sized instruments inserted through small incisions around your shoulder.
Many times, manipulation and arthroscopy are combined to obtain maximum results. Most patients have very good outcomes with these procedures.
What is the recovery from Frozen Shoulder?
Physical therapy is necessary after surgery to maintain the motion. Recovery can be 6 weeks to three months and your commitment to therapy is the most important factor in returning to activities. Long-term outcomes after surgery are generally good, with most patients having reduced or no pain and greatly improved range of motion. In some cases, however, even after several years, the motion does not return completely and a small amount of stiffness remains. Although uncommon, frozen shoulder can recur, especially if a contributing factor like diabetes is still present.