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Joseph Norris, MD
Orthopedic Surgeon Sports Medicine

Frozen Shoulder

Frozen ShoulderDefinition

  • Adhesive capsulitis is when the shoulder is painful and loses motion because of inflammation

Alternative Names

  • Frozen shoulder

Causes and Risk Factors

  • The capsule of the shoulder joint has ligaments that hold the shoulder joint together. When the capsule becomes inflamed, the shoulder is unable to move freely
  • Most of the time there is no cause for frozen shoulder

Risk factors include, in no particular order:

  • *Diabetes
  • Shoulder injury
  • Shoulder surgery
  • *Thyroid problems
  • Long periods of immobilization

Symptoms
The main symptoms are:

  • Decreased motion of the shoulder
  • Pain
  • Stiffness
  • Frozen shoulder without any known cause starts with pain. This pain prevents you from moving your arm. Lack of movement leads to stiffness and then even less motion. Over time, you become unable to do movements such as reaching over your head or behind you.

Signs and Tests

  • Adhesive capsulitis is a clinical diagnosis, often made when you are not able to rotate your shoulder or have pain in every direction, especially at the extremes
  • X-rays are routinely performed to assess the bones and especially arthritis of the glenohumeral joint (shoulder joint)
  • MRI is not routinely needed

Treatment

  • Pain is treated with nonsteroidal anti-inflammatory medications (NSAIDs) and steroid injections
  • Steroid injections plus physical therapy can improve your motion
  • It can take a few weeks to see progress. It may take as long as 6 – 9 months for complete recovery. Physical therapy is intense and needs to be done every day
  • If left untreated, the condition often gets better by itself within 18 months with little loss of motion
  • Surgery is recommended if nonsurgical treatment is not effective
  • This procedure (shoulder arthroscopy) is done under anesthesia
  • During surgery the scar tissue is released by bringing the shoulder through a full range of motion (Manipulation Under Anesthesia (MUA)
  • Arthroscopic surgery can also be used to cut and remove the scar tissue from the shoulder (arthroscopic lysis of adhesions)
  • After surgery you participate in intense physical therapy to gain back your motion

Prognosis

  • Treatment with physical therapy and NSAIDs will usually restore motion and function of the shoulder within 3-6 months, if left untreated the shoulder can get better by itself in 12-18 months
  • After surgery restores motion, you must continue physical therapy for several weeks or months to prevent the frozen shoulder from returning. Treatment may fail if you cannot keep up with physical therapy

Complications

  • Stiffness and pain continue even with therapy
  • The arm can break if the shoulder is moved forcefully during surgery, but this is very rare and seldom happens
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