Causes of Frozen Shoulder
The shoulder joint is enclosed in a capsule of connective tissue. Frozen shoulder occurs when this capsule thickens and tightens around the shoulder joint, restricting its movement.
It’s unclear why this happens to some people. But it’s more likely to happen after keeping a shoulder still for a long period, such as after surgery or an arm fracture.
Risk Factors include:
- Diabetes
- Thyroid problems
- Changes in your hormones, such as during menopause
- Shoulder injury
- Shoulder surgery
- Open heart surgery
- Cervical disk disease of the neck
Symptoms of Frozen Shoulder
Frozen shoulder typically develops slowly in three stages.
- Freezing stage: Any movement of the shoulder causes pain, and the shoulder’s ability to move becomes limited. This stage lasts from 2 to 9 months.
- Frozen stage: Pain might lessen during this stage. However, the shoulder becomes stiffer. Using it becomes more difficult. This stage lasts from 4 to 12 months.
- Thawing stage: The shoulder’s ability to move begins to improve. This stage lasts from 5 to 24 months.
- For some people, the pain worsens at night, sometimes disrupting sleep.
The main symptoms include:
- Pain: dull, aching pain that increases as the disease progresses, and may worsen when you move your arm.
- Decreased motion of the shoulder
- Stiffness: stiffness that worsens at first, but gradually begins to improve over time
Risk Factors of Frozen Shoulder
Age: People 40 and older, particularly women, are more likely to have frozen shoulder.
Immobility: People who’ve had to keep a shoulder somewhat still are at higher risk of developing frozen shoulder. Restricted movement can be the result of many factors, including:
- Systemic diseases: Diabetes
- Overactive thyroid (hyperthyroidism)
- Underactive thyroid (hypothyroidism)
- Cardiovascular disease
- Parkinson’s disease
Prognosis of Frozen Shoulder
Most frozen shoulders get better on their own within 12 to 18 months but with persistent and severe symptoms, steroid injections or surgery are treatment options
Diagnosis of Frozen Shoulder
Diagnosing frozen shoulder requires a physical examination and possible X-rays or additional tests to rule out other causes of symptoms and may include the following:
Medical History: Discussion of symptoms, past medical conditions, and any history of neck injuries.
Physical Examination: Assessment of reflexes, muscle strength, and sensation.
Diagnostic Imaging: Your physician may order several tests, such as X-rays, to rule out other potential causes of a painful shoulder or limited shoulder motion (arthritis, calcium deposits, etc.).
Pain Medicine Intervention
The two main goals of treatment and intervention are to increase motion and to decrease pain. Options include:
Conservative Treatments: Non-surgical approaches include:
- Physical Therapy: Physical Therapy is the cornerstone of treatment, especially concentrating first on exercises that stretch the joint capsule, and later, on strengthening exercises.
- Steroid injections: Injecting corticosteroids into the shoulder joint might help decrease pain and improve shoulder mobility, especially if given soon after frozen shoulder begins.
- Anti-inflammatory Medication: such as aspirin, ibuprofen (Motrin, Advil), or naproxen (Aleve, Naprosyn, Anaprox)
- Ice: an ice pack or bag of frozen vegetables applied to the shoulder for 10 to 15 minutes several times a day can also help with pain
- corticosteroid injection into the shoulder joint or soft tissues
- Hydrodilatation. Injecting sterile water into the joint capsule can help stretch the tissue and make it easier to move the joint. This is sometimes combined with a steroid injection.
- Shoulder manipulation. This procedure involves a medication called a general anesthetic, so you’ll be unconscious and feel no pain. Then the care provider moves the shoulder joint in different directions to help loosen the tightened tissue.
Treatment of Frozen Shoulder
If pain and limited mobility persists, surgery may be recommended and could be the following:
Manipulation under anesthesia: During this surgery, you’ll be put to sleep and your provider will force movement of your shoulder. This will cause your joint capsule to stretch or tear to loosen the tightness. This will lead to an increase in your range of motion.
Shoulder arthroscopy: Your provider will cut through the tight parts of your joint capsule (capsular release). They’ll insert small, pencil-size instruments through small cuts (incisions) around your shoulder.
Procedure Videos
Peripheral nerve block (suprascapular axillary and lateral pectoral nerves)
References
- Frozen shoulder (adhesive capsulitis). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/frozen-shoulder-adhesive-capsulitis. Accessed June 27, 2024.
- Frozen shoulder: Diagnosis & treatment. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/frozen-shoulder/diagnosis-treatment/drc-20372690. Accessed June 27, 2024.
- Frozen shoulder. Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/frozen-shoulder. Accessed June 27, 2024.
- Frozen shoulder. Penn Medicine. https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/frozen-shoulder. Accessed June 27, 2024.
- How to release a frozen shoulder. Harvard Health. https://www.health.harvard.edu/pain/how-to-release-a-frozen-shoulder. Accessed June 27, 2024.
