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Frozen shoulder

Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by stiffness and pain in your shoulder joint. Signs and symptoms begin gradually, worsen over time and then resolve, usually within a two-year period.

Your risk of developing frozen shoulder increases if you've recently had to have your arm in a sling for several weeks, or if you have had surgery in which your arm was immobilized in a specific position for a prolonged period.

Treatment for frozen shoulder involves stretching exercises and, sometimes, the injection of corticosteroids and numbing drugs into the joint capsule. In a small percentage of cases, surgery may be needed to loosen the joint capsule so that it can move more freely.

Frozen shoulder typically develops slowly, and in three stages. Each of these stages can last a number of months.

• Painful stage. During this stage, pain occurs with any movement of your shoulder, and your shoulder's range of motion starts to become limited.
• Frozen stage. Pain may begin to diminish during this stage. However, your shoulder becomes stiffer, and your range of motion decreases notably.
• Thawing stage. During the thawing stage, the range of motion in your shoulder begins to improve.

For some people, the pain worsens at night, sometimes disrupting normal sleep patterns.

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Frozen shoulder

The bones, ligaments and tendons that make up your shoulder joint are encased in a capsule of connective tissue. Frozen shoulder occurs when this capsule thickens and tightens around the shoulder joint, restricting its movement.

Doctors aren't sure why this happens to some people and not to others, although it's more likely to occur in people who have recently experienced prolonged immobilization of their shoulder, such as after surgery or an arm fracture. Because of the high incidence of frozen shoulder in people with diabetes, there may be an autoimmune basis to the disease.

Although the exact cause is unknown, certain factors may increase your risk of developing frozen shoulder.

Age and sex
People 40 and older are more likely to experience frozen shoulder. About 70 percent of the people who develop the condition are women.

Immobility
People who have experienced prolonged immobility of their shoulder are at higher risk of developing frozen shoulder. Immobility may be the result of many factors, including:

• Rotator cuff injury
• Broken arm
• Stroke
• Recovery from surgery

Systemic diseases
People who have certain medical problems appear to be predisposed to develop frozen shoulder. Examples include:

• Diabetes
• Overactive thyroid (hyperthyroidism)
• Underactive thyroid (hypothyroidism)
• Cardiovascular disease
• Tuberculosis
• Parkinson's disease

While you may initially consult your family physician, he or she may refer you to a doctor who specializes in orthopedic medicine.

What you can do
You may want to write a list that includes:

• Detailed descriptions of your symptoms
• Information about medical problems you've had
• Information about the medical problems of your parents or siblings
• All the medications and dietary supplements you take
• Questions you want to ask the doctor

What to expect from your doctor
During the physical exam, your doctor may ask you to perform certain actions, to check for pain and evaluate your range of motion. These may include:

• Hands up. Raise both your hands straight up in the air, like a football player who's just made a touchdown.
• Opposite shoulder. Reach across your chest to touch your opposite shoulder.
• Back scratch. Starting with the back of your hand against the small of your back, reach upward to touch your opposite shoulder blade.

Your doctor may also ask you to relax your muscles while he or she moves your arm for you. This test can help distinguish between frozen shoulder and a rotator cuff injury.

Your doctor may also check the musculoskeletal and neurological health of your shoulder joint and arm by testing your:

• Reflexes
• Muscle strength
• Muscle tone
• Sensation

Frozen shoulder can usually be diagnosed from signs and symptoms alone. But your doctor may suggest imaging tests — such as X-rays or an MRI — to rule out other structural problems.

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Shoulder exercises

Most frozen shoulder treatment involves controlling shoulder pain and preserving as much range of motion in the shoulder as possible.

Medications

• Nonsteroidal anti-inflammatory drugs (NSAIDs). These medications may help relieve pain and inflammation associated with frozen shoulder. Acetaminophen (Tylenol, others) also may be effective for pain relief.
• Corticosteroids. Injecting these anti-inflammatory medications into your shoulder joint may help decrease pain and shorten symptom duration during the initial painful phase. Repeated corticosteroid injections aren't recommended.

Therapy
A physical therapist can teach you exercises to help maintain as much mobility in your shoulder as possible, without stressing your shoulder to the point of causing a lot of pain.

Surgical and other procedures

• Distension. Injecting sterile water into the joint capsule can help stretch the tissue and make it easier to move the joint.
• Shoulder manipulation. In this procedure, you're given general anesthesia and then the doctor moves your shoulder joint in ways that help loosen the tightened tissue.
• Surgery. In a small number of cases, especially if your symptoms don't improve despite other measures, surgery may be an option to remove scar tissue and adhesions from inside your shoulder joint. Doctors usually perform this surgery arthroscopically, with a lighted, tubular instrument inserted through a small incision in your joint.

Continue to use the involved shoulder and extremity in as many daily life activities as possible within the limits of your pain and range of motion constraints. Applying heat or cold to your shoulder can help relieve pain.

Acupuncture
Acupuncture is a pain-killing procedure that has been used in China for thousands of years. It involves inserting extremely fine needles in your skin at specific points on your body. Typically, the needles remain in place for 15 to 40 minutes. During that time they may be moved or manipulated. Because the needles are hair thin and flexible and are generally inserted superficially, most acupuncture treatments are relatively painless.

Transcutaneous electrical nerve stimulation (TENS)
A TENS unit delivers a tiny electrical current to key points on a nerve pathway. The current, delivered through electrodes taped to your skin, isn't painful or harmful. It's not known exactly how TENS works, but it's thought that it might stimulate the release of pain-inhibiting molecules (endorphins) or block pain fibers that carry pain impulses.

One of the most common causes of frozen shoulder is the immobility that may result during recovery from a shoulder injury, broken arm or a stroke. If you've had an injury that makes it difficult to move your shoulder, talk to your doctor about what exercises would be best to stretch the tough capsule around your shoulder joint.