Frozen Shoulder
By Brett Jameson, M.D.
Many of us have heard of frozen shoulder, however, what it is and what causes it, are not as clear. Hopefully, this article can answer some common questions. Another name for frozen shoulder is adhesive capsulitis.
A frozen shoulder is stiffness and pain in the shoulder. It usually develops after a shoulder injury that causes pain and does not allow the shoulder to move enough. Over time, the capsule surrounding the shoulder joint becomes very stiff. The joint then develops scar tissue, or adhesions. It then becomes a vicious cycle of pain, restriction of movement, pain, etc. Even a minor strain can start the problem. Other conditions that can cause adhesive capsulitis include arthritis, or diabetes. Other times there is no known cause.
Symptoms of frozen shoulder include pain and decrease in range of motion. The shoulder will lose its normal ability to move in all directions. Lifting the arm above the head or being able to scratch the back will be difficult and painful. Sometimes a grinding sensation with movement will be noticed. Symptoms will progress with time.
To diagnose frozen shoulder, a complete shoulder exam needs to be done. X-rays are taken to rule out a fracture or arthritis. Sometimes an MRI will be done. Once a diagnosis has been made, treatment can begin.
The first step of treatment is physical therapy, in which a supervised exercise program can be started. Home exercises will also be started. An anti-inflammatory medication, such as, Aleve, Ibuprofen, or Naprosyn will also be started. Another option for treatment is a corticosteroid injection into the shoulder joint. The medication and injection are to treat the inflammation caused by this condition. Ice should also be used many times a day. In cases that do not respond to conservative treatment, a "manipulation under anesthesia" is done. In this procedure, the patient is put to sleep with a general anesthetic and the surgeon will move the shoulder in various directions to break up the adhesions.
The goal of rehabilitation is to return to sports or activities as soon as safely possible. To quick of return can worsen the injury. Everyone recovers at a different rate. Return to activity should be determined by how soon the shoulder recovers, not by how much time has occurred since the injury. In general, the longer the symptoms have been going on, the longer it will take to get better. A return to sports or activities can occur when, the shoulder has full range of motion without pain, and normal strength compared to the uninjured shoulder has been regained.
Prevention is important. After an injury to the shoulder has occurred, it is important to not limit shoulder motion for a prolonged period of time. It is also important to do shoulder rehabilitation as prescribed. If shoulder range of motion is lost, always see your medical provider.
