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What Is A "Frozen Shoulder?"

Shoulder Adhesive Capsulitis, also called "Frozen Shoulder" is a common condition occurring more prevalently in women over the age of 40 and is commonly thought to occur in the diabetic population as well as people with known thyroid disease. We’ve seen many patients from Raleigh, Cary, Apex, Garner and the Triangle who suffer from this condition and come to us seeking relief.

The symptoms of shoulder adhesive capsulitis are significant shoulder stiffness and shoulder pain with primarily limitation of overhead and rotational motions of the joint. Pain is reported mostly at night. The actual physiology of this condition is one in which the capsule or stabilizing ligaments of the shoulder become inflamed and ultimately contract or shorten significantly. The condition has been noted to occur in both shoulders in approximately 10% of population.

What Causes Shoulder Adhesive Capsulitis?

The exact cause of shoulder adhesive capsulitis is not known. It may occur for no apparent reason but is also seen after significant injury such as a fall, dislocation or fracture of the shoulder. Frozen shoulder may also occur secondarily after surgical procedures of the thorax, breast or spine. Once the condition has run its course, recurrence in the same shoulder is rare.

Is There Any Treatment For Frozen Shoulder?

Shoulder adhesive capsulitis can take 6 - 24 months to resolve completely. It generally will resolve on its own but recovery can be assisted by a regimen of physical therapy exercises during the latter phases.

The literature defines 3 distinct phases of the frozen shoulder condition:

PHASE 1. FREEZING PHASE. This phase is the most notably painful of all phases and may last form 2-9 months if not longer in patients with other medical conditions. Pain is noted almost continually of varying levels with rest, activity and at night. Significant loss of shoulder range of motion is also realized.

PHASE 2. FROZEN PHASE. In this phase, stiffness continues to worsen and may last between 4 months to one year. Pain is experienced usually only at the end available ranges of motion.

PHASE 3. THAWING PHASE. In this phase, the shoulder begins to loosen or "thaw" and should resolve between 12-24 months from onset. Pain is greatly reduced and is usually only experienced at the ends of the available, improving ranges of motion.

Most patients realize a complete resolution of pain and a full return of strength and range of motion. In a small percentage of the population there exists permanent minimal loss of mobility which is barely if ever considered a limitation or worry.

Additional consideration should be taken over the recovery course to determine if there is any arthritic component to this condition.In the early and mid phases of this condition X-rays may not document early arthritic changes that may become apparent later, possibly a year into the condition.

Is There Any Treatment For This Condition

Diagnosis to rule out any bony pathology as well as rotator cuff tear by recognizing an insidious onset vs traumatic injury allows the patient to understand that this is a condition that should eventually resolve with conservative care. The condition is somewhat self restrictive in nature meaning that you will be encouraged to use the arm as much as possible within reasonable means. Pain medicine and or anti-inflammatories can be helpful, especially in the freezing phase to help you work and rest. You should not immobilize the arm unless the pain is unbearable.

In the event of severe and constant discomfort, your physician may consider a steroid injection. Unfortunately, in this instance the relief may not occur or at best be temporary in nature. Keep in mind that this type of injection does bear slight risk of infection so benefits vs risks should be weighed accordingly.

Other treatment approaches that have found to be beneficial over time include physical therapy for local modalities and pain control. This can also be performed in concert with PT sessions of range of motion, stretching and techniques called joint mobilization which encourage the shoulder joint to stretch within itself and move more normally. Physical therapy also assists you in progressive home exercises as you gradually regain mobility and strength.

Your Physical Therapist can instruct you in the proper approach and frequency to perform your home exercises.

In the event that you have not progressed according to the previously mentioned time frames, your physician may suggest you consider "manipulation under anaesthesia. In this procedure, your orthopaedic physician, under anaesthesia will gradually and progressively move the shoulder and arm through the normal range of motion, carefully disrupting the restrictive adhesions that have formed within the joint capsule. This procedure will normally be followed by 3-4 months of physical therapy to regain range of motion and function. Risks vs benefits should be weighed with those risks being the anaesthesia as well as a small risk of arm fracture.

In rare cases the condition does not resolve and becomes chronic. If all other treatment options have failed, the orthopaedic surgeon may want you to consider a procedure known as Capsular Release performed arthroscopically. In this procedure it is possible to release the contracted tissue. Post operatively the patient will require aggressive physical therapy which may take 6 months.

The general recommendation for the majority of our population is to secure the exact diagnosis, manage the pain and stiffness with anti-inflammatories, pain medicine and light exercise, attempting to use the arm as much as possible. Understand that this condition normally resolves over time.

For more information on how the frozen shoulder specialists at Cary Orthopaedics can help you, contact us today at 919-467-4992 for an appointment!

Cary Orthopaedics serves patients from Raleigh, Garner, Cary, Apex, Holly Springs, Fuquay-Varina, Clayton, Chapel Hill, and Pittsboro, NC