What is frozen shoulder, what causes it and how is frozen shoulder treated?

Aptly named, a frozen shoulder feels as if your shoulder is nearly frozen in place, unable to move or perform as it should. Also called adhesive capsulitis, frozen shoulder is a painful condition that causes inflammation and stiffness that increases over time. If you believe you have a frozen shoulder, it’s important to see an orthopedic shoulder specialist for proper diagnosis, as common frozen shoulder symptoms can also be caused by a different disease or injury.  

Frozen Shoulder Anatomy

The shoulder is a ball-and-socket joint that contains synovial fluid, which is a gel-like substance that provides lubrication and cushions the shoulder joint. Three bones make up the shoulder joint: the humerus (upper arm), the scapula (shoulder blade) and the clavicle (collarbone).

The humerus fits into the scapula and strong connective tissue called the shoulder joint capsule that surrounds the joint and rotator cuff tendons. Additionally, the shoulder joint capsule contains the ligaments that connect the humerus head to the glenoid (shoulder socket), which helps stabilize the joint.

Frozen shoulder occurs when this collective tissue becomes inflamed, thickens and becomes tight. As this happens, adhesions – or thick bands of tissue – form and there is less synovial fluid in the shoulder joint to pad the bones and reduce friction.

Stages of Frozen Shoulder

There are three stages of frozen shoulder: the “freezing” stage, the “frozen” stage and the “thawing” stage.

Freezing Stage

In this first stage, the shoulder begins to become painful and difficult to move. As the pain increases over time, the less the shoulder is used. This lack of use may alleviate some pain; however, the less the shoulder is used, the thicker the shoulder joint’s collective tissue becomes. The freezing stage usually lasts for 6 weeks to 9 months.

Frozen Stage

In the second stage, the stiffness typically remains but the pain may noticeably lessen. While it may “feel” better, the frozen shoulder makes daily tasks and activities difficult or impossible. This stage can last 2 to 6 months.

Thawing Stage

In the final stage of frozen shoulder, mobility slowly improves and the pain lessens. It takes anywhere from 6 months to 2 years to return to normal strength and mobility.

Frozen Shoulder Symptoms, Causes & Risk Factors

The two main symptoms of frozen shoulder are pain and stiffness. The pain is typically a dull, achy pain that is worse at night, when you move your arm and during the freezing stage of the disease. Frozen shoulder pain usually affects the outer shoulder and the upper arm. Depending on what stage you’re in (freezing, frozen or thawing), your symptoms will vary.

Unfortunately, orthopedic shoulder specialists do not fully understand the causes of frozen shoulder. Interestingly, there is no evidence of connection between arm dominance or occupation and frozen shoulder.

However, certain risk factors have been attributed to frozen shoulder.

Age & Sex

People over 40, especially women, have shown higher rates of frozen shoulder.

Injury & Reduced Mobility

Prolonged immobility due to rotator cuff injuries, broken arms and recovery from surgery presents a risk for frozen shoulder.

Diabetes

According to the Cleveland Clinic, 10 to 20 percent of people with diabetes develop frozen shoulder at some point in their lives.

Other Diseases & Health Conditions

Strokes, hypothyroidism, hyperthyroidism, heart disease, tuberculosis, Parkinson’s disease and stroke are all risk factors for frozen shoulder. While the immobility caused by a stroke can lead to frozen shoulder, orthopedic doctors do not know why these other diseases can cause frozen shoulder.

Frozen Shoulder Treatments

While frozen shoulder typically gets better over time on its own, it can take up to 3 years if left untreated. Most treatments for frozen shoulder are aimed at pain management and restoration of mobility and strength.

No-Surgical Treatments

Physical Therapy

Physical therapy can help restore motion through stretching and range of motion exercises.

Non-steroidal Anti-inflammatory Drugs (NSAIDs)

Over-the-counter medications like ibuprofen, aspirin and acetaminophen can help reduce pain and swelling.

Steroid injections

Cortisone injections directly into the shoulder joint can reduce inflammation and pain longer than NSAIDs.

Hydrodilatation

If other non-surgical treatments fail to relieve your symptoms, your orthopedic shoulder doctor may recommend this treatment. Hydrodilatation is where a large volume of sterile fluid is injected into the shoulder joint to expand the shoulder joint capsule.

Surgical Treatment

If conservative methods do not work in treating your frozen shoulder, your orthopedic surgeon may recommend surgery. Surgery for a frozen shoulder typically occurs during the frozen stage and includes both manipulation under anesthesia and shoulder arthroscopy. Your shoulder surgeon will likely perform one or both procedures if necessary to release your frozen shoulder.

If you have any questions about frozen shoulders or would like to talk to an orthopedic shoulder specialist, please contact us and we’ll be happy to help.

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