Treating Frozen Shoulder

Adhesive capsulitis, also known as frozen shoulder, is a common affliction among adults, affecting approximately one in five people between the ages of 40 and 60. Often a result of not using the joint properly due to disease  (including arthritis and diabetes) or injury, frozen shoulder is marked by pain, stiffness and limited range of motion in the shoulder joint.

How the Shoulder Works

Three bones come together to form the shoulder, which is a ball-and-socket joint. The humerus, or upper arm bone, fits into a socket located in the scapula, or shoulder blade. The joint is surrounded by thick tissue, known as the shoulder capsule, which connects the joint to the clavicle, or collarbone. The entire apparatus is lubricated by synovial fluid, which keeps everything moving smoothly.

In a healthy shoulder, the shoulder capsule remains flexible, with plenty of joint fluid to ensure you have a full range of motion. However, when you don’t use the joint enough, the shoulder capsule thickens, becoming inflexible and inflamed. The amount of joint fluid then decreases. In time, you lose all range of motion in the shoulder and cannot move it at all either on your own or with help.

Diagnosis

Because frozen shoulder is painful and limits patient activity, it’s important to treat it as soon as possible. Ideally, treatment will begin in the early stages when the shoulder begins to freeze, but even a fully frozen shoulder can be treated to restore full range of motion.

Patients experiencing shoulder pain should see a doctor, who will run several tests to determine whether adhesive capsulitis is present and, if so, how far along it is. A physical exam, testing both active and passive range of motion (in other words, the range of motion possible when you move your arm yourself and then with assistance) can often lead to a frozen shoulder diagnosis. In some cases, your doctor may perform X-rays, MRI tests or ultrasounds to rule out other causes for the pain.

Common Treatment Plans

In the majority of cases, patients can restore the range of motion in their shoulder without surgical intervention, although it may take up to three years to be completely pain-free. Treatment usually consists of physical therapy to restore range of motion combined with steroid injections and non-steroidal pain relievers to reduce pain and inflammation.

In about 10 percent of cases, when therapy and medication don’t provide relief, surgery is necessary. There are two types of surgery for this condition, and they are often used in combination to achieve full recovery: manipulation under anesthesia and arthroscopy. In the first surgery, you are put under full sedation while your doctor forces the shoulder to move, causing the tightened capsule and the scar tissue to tear or stretch, thereby loosening the shoulder. In an arthroscopic procedure, your surgeon will use small instruments to cut through the tightened tissue through a series of incisions around your shoulder. In most cases, with physical therapy, patients who undergo surgery have full or almost full range of motion in three months.

Frozen shoulder is a painful condition, but not one that you need to live with. If you are experiencing symptoms and you suspect your shoulder may be freezing, schedule an appointment with your doctor today.