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Frozen Shoulder

Frozen Shoulder

What is frozen shoulder?

Frozen shoulder is a common condition that causes a loss of the range of movement of the shoulder as well as pain and stiffness. People aged 40 through 60 are more likely to develop it and it can get progressively worse with time if not treated.

Frozen shoulder may also be called adhesive capsulitis.

What causes frozen shoulder?

Our shoulder consists of a complex arrangement of muscles, tendons, and ligaments that allow it a greater range of motion than any other part of our body, but also make it vulnerable to trauma as well as chronic wear and tear. The joint is protected by a flexible capsule that contains a lubricant called synovial fluid that keeps it moving smoothly. A shoulder becomes frozen when the flexible capsule that protects the joint contracts and stiffens.

Doctors do not fully understand why frozen shoulder develops; however, it does appear to be an inflammatory process that may be triggered by long periods of immobilization due to injury (such as a fracture), overuse (such as bursitis or tendinitis of the rotator cuff), surgery, or illness.

During long periods of immobilization, the joint tissue thickens and contracts and loses its normal capacity to stretch. This causes pain, and pain tends to limit how much people move their shoulder, which leads to further contraction of the capsule and the joint may lose its synovial fluid. Adhesions (scar tissue) may form between the joint capsule and the top of the arm bone (humerus).

People more at risk of frozen shoulder include those:

  • Who don't receive exercise therapy after tendinitis or an injury
  • Who wear a sling for more than a few days without intermittent stretching
  • With a rotator cuff disorder
  • Subject to enforced mobility, such as after a stroke, a heart attack, or surgery
  • With a medical condition such as Parkinson’s disease or a thyroid disorder.

What are the symptoms of frozen shoulder?

A frozen shoulder may take two to nine months to develop. Although the pain may slowly improve, stiffness continues, and range of motion remains limited. Symptoms may include:

  • Pain and stiffness that makes it difficult or impossible to move the joint
  • Dull or achy pain in one shoulder
  • Worsening pain at night
  • Difficulty sleeping because of pain
  • After 6 to 9 months the pain may improve but the stiffness gets worse and it becomes harder to get through daily activities
  • Eventually, the range of motion starts to go back to normal.

How is a frozen shoulder diagnosed?

See your doctor or a physiotherapist if you think you have a frozen shoulder or are developing one. The clinician will ask you to perform various movements with your arm to assess your range of motion. Imaging tests may also be conducted, such as X-rays to check for any underlying problems, such as arthritic changes or dislocation, or an MRI to check for a rotator cuff tear.

How is frozen shoulder treated?

Treatment focuses on relieving pain and restoring the shoulder’s normal range of motion. In most cases the shoulder can be unfrozen; however, this usually takes some time and requires the person with the frozen shoulder to commit to a strengthening and stretching program. Other treatments may include:

  • Anti-inflammatory medicines, such as ibuprofen or naproxen
  • Ice packs applied to the shoulder several times a day
  • Corticosteroid injections
  • Avoidance of activities that require overhead reaching or lifting or which aggravate the pain.

Full recovery from a frozen shoulder may take from several months to two or three years. Rarely, surgery may be required.