Frozen Shoulder – Shoulder Elbow

Frozen Shoulder (Adhesive Capsulitis)

An Overview

Frozen shoulder is often caused by inflammation of the capsule, tissue surrounding the shoulder joint
Diagnosing frozen shoulder requires a physical examination and possible X-rays or additional tests to rule out other causes of symptoms
Physical therapy and anti-inflammatory medication are usually prescribed to treat frozen shoulder
Surgery is not usually indicated to treat frozen shoulder unless non-operative treatments have failed to improve range of motion and decrease pain

The shoulder is a ball-and-socket joint made up of three bones: upper arm bone (humerus), shoulder blade (scapula), and collarbone (clavicle)
The head of the upper arm bone fits into a shallow socket in the shoulder blade
Strong connective tissue, called the shoulder capsule, surrounds the joint
To help the shoulder move more easily, synovial fluid lubricates the shoulder capsule and the joint
The shoulder capsule surrounds the shoulder joint and rotator cuff tendons

Frozen shoulder, also called adhesive capsulitis, causes pain and stiffness in the shoulder
Over time, the shoulder becomes very hard to move
It most commonly affects people between the ages of 40 and 60, and occurs in women more often than men
People with diabetes are at an increased risk for developing frozen shoulder

In this condition the joint movement reduces drastically
Essentially scar tissue (adhesions) build up in the joint which prevents the shoulder from moving freely
This can happen after an injury, after an operation or it can happen in association with certain medical conditions e.g diabetes.
Patients with this condition will experience pain, and limited movements
It can resolve in time if it is mild or it may need medical attention and treatment

A frozen shoulder is most often caused by inflammation (swelling, pain and irritation) of the tissues surrounding the joint.
The tissue that envelops the joint and holds it together is called the capsule.
Normally the capsule has folds that can expand and contract as the arm moves into various positions.
In a frozen shoulder, the capsule has become inflamed and scarring develops. The scar formations are called adhesions.
As the capsule’s folds become scarred and tightened, shoulder movement becomes restricted and moving the joint becomes painful.
This condition is called adhesive (scarring) capsulitis (inflammation of the capsule).

There are three stages in which Frozen Shoulder develops

Painful symptoms may actually improve during this stage, but the stiffness remains
During the 4 to 6 months of the “frozen” stage, daily activities may be very difficult

Shoulder motion slowly improves during this stage
Complete return to normal or close to normal strength and motion typically takes from 6 months to 2 years

First the doctor takes a complete history and examines physically
The doctor 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.)
This may need to be supplemented by an ultrasound or MRI scan in order to rule out damage to the rotator cuff tendons

The two main goals of treatment are to increase motion and to decrease pain.

To increase motion, physical therapy is usually prescribed.
The physical therapist moves the patient’s arm to stretch the capsule and teaches the patient home exercises that may include use of a wand or overhead pulley.
He or she may also use ice, heat, ultrasound or electrical stimulation.
The therapist will demonstrate a stretching program that can be done at least once or twice a day. These exercises include the use of a cane, a home pulley system and an elastic cord to increase motion of the shoulder.
To decrease pain, physicians frequently recommend anti-inflammatory medications such as aspirin, ibuprofen (Motrin, Advil), Naprosyn or Aleve.
Pain pills such as Tylenol or narcotics may be prescribed to decrease the pain after therapy or to help with sleep at night.
Steroid injections of the joint or the bursa may be indicated and can be performed in outpatient clinics or by radiologist under ultrasound guidance.
Ultrasound guided hydrodilatation involves injection of fluid into the shoulder joint ( to dilate the capsule ) along with steroid injection and is widely performed with good results.

The initial supervised physical therapy usually lasts from one to six weeks, with the frequency of visits ranging from one to three times per week.
The patient should engage in home exercises and stretching throughout the healing process. The stretching exercises should be done at home at least once or twice daily.
Usually frozen shoulders will resolve almost completely with time and consistent compliance with the prescribed treatment program.
This process can vary from six to nine months for some patients, although it may take upto a year also to resolve. In diabetic patients, it takes longer and they often have recurrence of frozen symptoms.

Internal rotation (moving the hand to the back pocket or up the middle of your back) is usually the motion that takes the longest to regain.

If the physical rehabilitation program does not improve the range of motion and decrease the pain, then surgery may be indicated.
After the patient has had a general or regional anesthetic, the physician may manipulate the shoulder in the operating room to break down the scarring.
Sometimes, an arthroscope (a small instrument with an attached camera placed into the shoulder through a small puncture-type incision) is used to directly cut or release the capsular adhesions.