Colorado Orthopedic News

frozen shoulder

Frozen Shoulder

Frozen shoulder is a condition that causes severe, painful restriction of motion in the shoulder joint. The pain, swelling, and stiffness make everyday activities more difficult. This gradually worsens over time and even affects your ability to sleep a restful night. Frozen shoulders can last for years without proper treatment. If you begin to feel shoulder pain, you shouldn’t wait to see the orthopedic specialists at Advanced Ortho in Denver, Parker, or Aurora, Colorado. There is no reason to suffer from pain and stiffness that can seriously interfere with your ability to do everyday tasks such as dress and bathe, wash your hair and even work.

Overview

In the medical community, a frozen shoulder is also called “adhesive capsulitis,” “painful, stiff shoulder,” and “periarthritis.” Nearly 3-5% of adults between 40-60 years old might encounter a frozen shoulder condition at some time in their lifetime. It occurs in over 20% of people with diabetes. The condition is called a “frozen” shoulder because the more pain that is felt, the less likely the shoulder will be used. Lack of use causes the shoulder capsule to thicken and becomes tight, making the shoulder even more difficult to move — it is “frozen” in its position. It’s unusual for a frozen shoulder to recur in the same shoulder, but some people can develop it in the other shoulder, usually within five years.

About The Shoulder

The shoulder is made up of three bones that form a ball-and-socket joint. Along with the tissues that hold everything together, the three bones that form the shoulder capsule are the humerus (upper arm), scapula (shoulder blade), and clavicle (collarbone). The head of the upper arm bone fits into a shallow socket in your 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. Normally the shoulder joint is one of the most mobile joints in the body.

What Is Frozen Shoulder?

The contraction of the capsule and the formation of the adhesions cause the frozen shoulder to become stiff and cause movement to become extremely painful. Frozen shoulder typically progresses through three different stages: freezing, frozen, and thawing.

Freezing Stage: most sufferers first become aware of the conditions by experiencing a dull, aching pain in the shoulder. In this first stage of frozen shoulder – which can last anywhere from two to nine months – the shoulder becomes painful, and stiffness slowly builds up, limiting a person’s overall movement.

Frozen Stage: the pain begins to subside in the upper arm and shoulder, but the stiffness and limitation to the range of motion in the joint capsule will increase. Patients may have sharp, acute nerve pain when making sudden movements or forceful movements beyond their normal limitations. The stage can last anywhere from four months to over a year.

Thawing Stage: During the third and final stage, the shoulder eventually begins to thaw, and the range of motion will return to normal. The thawing stages take anywhere from two to three years in 90% of cases.

Frozen Shoulder Causes

Doctors are not certain about the exact cause of frozen shoulder in some people, but some of the potential causes and those at risk include:

  • Reduced immobility due to conditions such as fractures, rotator cuff injuries, and broken arms
  • Inflammation of the muscles and/or tendons, as with rotator tendinitis or bursitis
  • Medical ailments and hormonal imbalances include diabetes, hyperthyroidism, hyperthyroidism, adrenal stress, menopause, testosterone imbalance, cardiovascular disease, Parkinson’s disease, stroke, and tuberculosis
  • Nerve compression in patients with lower neck disc conditions or muscle contraction conditions
  • Chronic inflammatory arthritis in the shoulder
  • After vaccinations
  • Age-people between the ages of 40 and 60
  • Gender–women are twice as likely to develop frozen shoulders than men

Non-surgical Treatment For Frozen Shoulder

The two main goals of treatment for a frozen shoulder are to increase motion and decrease pain. To increase motion, physical therapy is usually prescribed. 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, as noted above. Generally, a frozen shoulder will resolve almost completely with time and consistent compliance with the prescribed treatment program. This process can take up to six to nine months for some patients, although it may take only a few months for others. 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. To decrease pain, physicians frequently recommend anti-inflammatory medications such as aspirin, Motrin, Advil, Naprosyn, or Aleve. Occasionally, steroid injections of the joint or bursa may be indicated. Steroids like prednisone may be given to help decrease inflammation.

When Is Surgery Indicated?

If the symptoms don’t resolve in 6 to 12 months and the above program does not improve the range of motion or decrease the pain, surgery may be an option. 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. Occasionally, 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.

Other operations, such as the removal of spurs, may also be indicated or required at the time of the manipulation. These operations can sometimes be done with the arthroscope but may require one or two larger incisions around the shoulder (open surgery).

Getting The Right Diagnosis

The first step is to have a complete history and physical examination by your physician. Experienced doctors can usually diagnose a frozen shoulder based on the symptoms it causes and how it limits movement. They will move your shoulder in all directions to see the range of motion and see if there is pain with movement. This type of exam, in which your doctor is moving your arm and not you, is called determining your “passive range of motion.” The doctor will also watch you move your shoulder to see your “active range of motion.” People with frozen shoulders have a limited range of both.

People with suspected frozen shoulders very rarely need imaging tests such as x-rays, magnetic resonance images (MRIs), or ultrasounds. Still, healthcare providers do sometimes order them to make sure other problems are not causing the symptoms. It is important to note that 10% of cases of frozen shoulder will not disappear without medical intervention. More than half of those who go without proper treatment will experience permanent damage as the body secretes enzymes into the synovial fluids of the joint, which eventually eats away the cartilage. In addition to deterioration of the joint, muscular atrophy (muscle waste) can also prolong recovery and make for a quite difficult recovery. This can be avoided by seeing one of the orthopedic shoulder specialists at Advanced Ortho in Denver, Parker, or Aurora, Colorado. They understand the complexities of a frozen shoulder and have years of experience treating it correctly. The goal of these experts is to do everything necessary to get you out of pain and on with life. Call (303) 344-9090 to schedule an appointment.

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