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Frozen Shoulder

Frozen Shoulder

What is a frozen shoulder?

Frozen shoulder is a common shoulder disorder characterized by a gradual increase of pain and limitation of range of motion of the shoulder joint.

The shoulder joint is surrounded by connective tissue called the capsule. Sometimes, the capsule can become thickened and inflamed, making the tissue more rigid and tight around the shoulder joint. This is called adhesive capsulitis, or frozen shoulder.

A frozen shoulder is a disease process where the joint becomes inflamed, followed by thickening of the shoulder capsule, development of adhesions (scar-like tissue) and reduced synovial fluid in the joint, which results in painful stiffening of the shoulder capsule.

What causes a frozen shoulder?

There is no single direct cause of frozen shoulder. FS is more common in women over 40 years of age, diabetics, and patients with thyroid disorders.  Adrenal disease, hyperlipidemia, and cardiopulmonary disease are also related to FS. However, FS can occur without a cause or preexisting condition.

Frozen shoulder can also occur in patients who have suffered a trauma such as a fracture, dislocation or soft tissue injury to the shoulder, or a nontraumatic condition like osteoarthritis, and rotator cuff deterioration.

A common cause is recovery from a shoulder injury or surgery where their shoulder has been immobilized for a period of time. This is the reason for range of motion therapy soon after an injury or surgery. In other cases, FS can develop from overuse.

What are the symptoms of a frozen shoulder?

FS symptoms are pain, difficulty sleeping, reduced range of motion, difficulty reaching the arm behind your back, and general shoulder stiffness. The pain is characterized as dull ache.

The natural course of the disease is divided into 3 phases:

Phase 1: spontaneous onset of shoulder pain with progressive loss of motion

Phase 2: gradually the pain subsides, with stiffness and reduced range of motion

Phase 3: thawing, gradual improvement in range of motion and resolution of symptoms

Full recovery can take years. However, this long period of disability and pain significantly interferes with routine life activities, and occupational and recreational activities. FS compromises quality of life,

How is FS diagnosed?

Your Ortho Illinois shoulder specialist will review your medical history, inquire about your symptoms, their onset and the extent of your disability. They will conduct a thorough physical examination of your shoulders and assess range of motion comparing the painful shoulder with the unaffected shoulder.

Radiographs, an MRI and possibly an ultrasound may be ordered to rule out specific causes and to identify other potential sources of your symptoms.

What are the treatments for FS?

Traditionally FS is viewed as a self-limiting and benign disease with complete recovery of pain and range of motion. Conservative management provides improvement in the condition in most cases.

Treatment includes anti-inflammatory medication and cortisone injections to reduce inflammation. Oral steroids can improve outcomes. Physical therapy is important for shoulder stretching to increase your range of motion. Frozen shoulder often resolves with time–up to six years.

Surgery may be recommended when pain and limited motion persist with 6 months of conservative management. Surgical options to resolve symptoms include manipulation under anesthesia and shoulder arthroscopy to release the capsule. During manipulation, the doctor will move your arm to free the scar tissue and capsule.

During shoulder arthroscopy, your doctor will make tiny incisions and use instruments to release the capsule. Shoulder arthroscopy for FS has shown excellent results in relief of pain and restoring range of motion. It is safe with a low complication rate. Rehabilitation is a very important part of any surgical treatment very important after surgery to maintain movement gains achieved with surgery.