Frozen Shoulder

What is frozen shoulder (adhesive capsulitis)?

Frozen shoulder occurs when the capsule (lining of the joint) becomes inflamed, thickened and tight. A normal healthy shoulder has a wide range of unrestricted motion.  Three bones make up the shoulder: the scapula (shoulder blade), the humerus (upper arm bone), and the clavicle (collarbone).  The shoulder joint is surrounded by a capsule which contains joint fluid that lubricates the shoulder joint.

Frozen shoulder causes the capsule to become thickened, tight and inflamed.  This process results in restricted motion and stiffness.   Frozen shoulder goes through several stages and may take up to 18 months to resolve. 

What causes frozen shoulder?

Generally, the cause of frozen shoulder is unknown.  The condition is more common in diabetics, people with thyroid conditions, and other medical problems such as stroke.  Women are more likely to develop frozen shoulder than men.  Frozen shoulder may occur after an injury to your shoulder, or it may occur after shoulder surgery including routine shoulder athroscopy. Frozen shoulder is often divided into stages, based on the symptoms:

Freezing: (0-6 months) The shoulder becomes painful with certain activities. Stiffness begins.

Frozen: (6-12 months) The shoulder is stiff, tight and painful.

Thawing: (12-18 months) The shoulder gradually begins to feel better and range of motion improves.


How is frozen shoulder diagnosed?

Frozen shoulder is usually diagnosed on physical examination.  Patients with frozen shoulder usually complain of pain with shoulder motion and stiffness in all directions. Many people first experience frozen shoulder as pain when reaching too far. Over time, they may realize that they are unable to perform basic tasks due to shoulder stiffness and pain, including such things as shaving under the arm or reaching a belt, bra strap, or back pocket. Usually a careful physical exam will confirm that substantial range of motion has been lost, both active (when you yourself try to range the shoulder) and passive (when the examiner tries to range and stretch your shoulder).  Occasionally, the thickened and inflamed capsule can be appreciated on MRI.

How is frozen shoulder treated?

Treatment of frozen shoulder initially starts with physical therapy, steroid injections into the shoulder, oral steroid medications, non-steroidal anti-inflammatory medication (NSAIDs).  NSAIDs include ibuprofen or prescription anti-inflammatories.  Cortisone is a strong steroidal anti-inflammatory.  Physical therapy is essential to regain your shoulder range of motion.  Treatment can be a very long process and may take up to 18 months to regain your motion and resolve your pain.

What happens if surgery is necessary?

When non-operative treatment fails, you may elect to have arthroscopic shoulder surgery.  Surgery consists of releasing the scar tissue surrounding the shoulder joint through tiny incisions.  This is called a capsular release.  The surgeon will also manipulate your shoulder by slowiy moving your shoulder while under anesthesia.  A capsular release and manipulation is usually done together to help regain your shoulder motion.  Physical therapy is essential after surgery.