Overview
Frozen shoulder is a disorder that affects the joints of your shoulder. Stiffness and pain are the most common symptoms that can gradually appear, worsen, and disappear. Freezing of the shoulder is common, but it can take up to three years for complete recovery. The main therapeutic prescription for frozen shoulder is physical therapy, emphasizing shoulder flexibility.
Frozen shoulder is more common in women than in men, and it often affects adults in their 40s to 60s. Frozen shoulder is also more prevalent among people with diabetes.
Anatomy
A ball-and-socket joint connects the three bones that make up your shoulder. Your collarbone (clavicle), upper arm (humerus), and the shoulder blade (scapula) are all affected. Your shoulder blade has a shallow slot where the upper arm bone’s head inserts. There is a layer of connective tissue encircling your shoulder joint which is referred to as the shoulder capsule.
Frozen shoulder causes the capsule to thicken and become very difficult to move. Zones of scar tissue grow, and synovial fluid, which helps keep joints lubricated, is depleted. These problems further restrict movement.
Description
The shoulder capsule tightens and hardens in a frozen shoulder. When adhesions are formed, they resemble thick bands of tissue. This may lead to a lack of joint synovial fluid.
The most common symptoms are intense discomfort and the inability to move the shoulder on your own or with the help of another person. There are three phases to its development:
Initial Stage
Freezing
- Your shoulder becomes painful (and perhaps swollen) if you try to move it.
- It gradually worsens over time, and it may ache more while you’re sleeping.
- In most cases, this will last for six to nine months.
- You’re restricted in the range of motion you can achieve with your arm.
Second Stage
Frozen
- Pain may subside, but stiffness grows worse.
- It gets increasingly difficult to move your shoulder and more challenging to go through everyday chores.
- This period might last anywhere from 4 to 12 months, depending on the individual.
Final Stage
Thawing
- Your range of motion begins to return to pre-injury levels.
- It takes from a few months to two years to finish the healing process.
Cause
The exact reasons for frozen shoulder are not known. It does not seem to be related to arm dominance or profession in any way. A few things may increase your chances of experiencing a frozen shoulder.
Diabetes
People with diabetes are twice as likely to suffer from frozen shoulder than the general population. It is not known what causes this to occur. Aside from that, diabetic people with frozen shoulders tend to have a higher degree of stiffness that lasts for a more extended period before “thawing.”
Other Diseases
Hypothyroidism and hyperthyroidism are both conditions that may occur in conjunction with frozen shoulder.
Immobilization
An immobile shoulder can lead to this condition. Anti-frozen shoulder measures include having patients exercise their shoulders as soon as possible following an accident or surgery.
Symptoms
Frozen shoulders often cause pain or numbness of the shoulder. Early in the condition (and mainly when you move your arm), pain can worsen. Discomfort is often felt in the upper arm, although it may also radiate to the outer shoulder.
Diagnosis
Dr. Howard will do a physical examination to determine whether you have a frozen shoulder. When he sees how severely it aches and how far it extends, he will take a closer look. He will let you flex your shoulder on your own during the “active” part of the test, and then move it for you and record the changes during the “passive” part.
He may recommend an injection of anesthetic into your shoulder. This painkiller will allow him to assess better your range of motion in both the active and passive modes.
A physical exam is usually enough to diagnose a frozen shoulder. Imaging tests such as MRI, X-rays, or an ultrasound may be used to rule out other possible causes of discomfort and restriction of movements, such as arthritis or a torn rotator cuff.
Treatment
Frozen shoulder typically improves with time, but it may take up to three years in some instances. The primary goal of physical therapy is to manage discomfort while also restoring mobility and strength.
Non-Surgical Treatment
Most individuals who suffer from frozen shoulder find relief with fundamental therapies that help manage discomfort and restore mobility.
Non-Prescription Anti-inflammatory drugs
Pain and swelling can be reduced by medications such as aspirin and ibuprofen (Advil, Motrin).
An Injection of steroids
When cortisone is injected directly into your shoulder joint, it can be very effective in reducing inflammation.
Hydro Dilatation
You may need hydro dilation if non-surgical approaches have failed to ease your pain. It is done by injecting a significant amount of sterile fluid into the shoulder joint to enlarge and lengthen the shoulder joint capsule. A radiologist performs hydro dilatation under imaging guidance to precisely put fluid in the target area.
Physical Therapy
Physical therapy can aid in the recovery of mobility. You may use a physical therapist or a self-guided program to carry out these exercises. Shoulder stretching or range of motion exercises are part of the treatment plan. Before stretching, the shoulder may benefit from being warmed up. The practices listed here are only a few of the many that can be used. Dr. Howard will create a physical therapy regimen designed just for you.
External Rotation – Passive Stretch
Bend your elbow at a 90-degree angle to grasp the doorjamb when standing in a doorway. Keep your hand in the same position and twist your body in the same way. For 30 seconds, keep your hands firmly in place. Relax and repeat.
Forward Flexion – Supine position
Your legs should be straight when you rest on your back. Your unaffected arm can help you elevate your affected arm to a comfortable position. When you’re done holding for 15 seconds, softly lower yourself back to the starting position.
Crossover Arm Stretch
Extend your arm as far as it will go across your chest, just behind your chin, without causing any discomfort. Take a deep breath and hold it for a full 30 seconds.
Surgical Treatment
If physiotherapy and other conservative approaches fail to reduce your symptoms, you and Dr. Howard may decide that surgery is the best option. He will discuss your recovery options, including the possibility of continuing with essential therapies and any dangers associated with the surgical procedures.
It is common for surgeons to recommend frozen shoulder surgery at “Stage 2: Frozen.” The purpose of surgery is to expand and loosen the rigid joint capsule. Techniques like manipulation under anesthesia and shoulder arthroscopy are the most often used.
Manipulation performed while under anesthesia
A sedative is used to put you asleep during this procedure. Your shoulder is forced to move so that the capsule and scar tissue loosens. This helps to reduce the tightness while also increasing the range of motion.
Arthroscopic surgery of the shoulder
During this surgery, your doctor will use a surgical blade to cut through any tight areas of the joint capsule. This is accomplished by using pencil-sized tools introduced through tiny incisions made around your shoulder area. In many instances, manipulation and arthroscopy are performed in conjunction to get the best possible outcomes. Most patients have positive results after undergoing these treatments.
Recovery
Physical therapy is required after surgery to preserve the range of motion acquired during these procedures. Recovery time frames can range from six weeks to three months, depending on the severity of the injury. Even though it is a lengthy process, your dedication to treatment is the most crucial aspect of your ability to return to everyday activities.
The long-term results of surgery are typically favorable, with most patients reporting decreased or no discomfort and increased range of motion following surgery. In some situations, the mobility may not return, and the joint can have some stiffness. After surgery, diabetics often have some degree of shoulder discomfort that persists.
It is possible for frozen shoulder to reoccur, even though it is rare, mainly if a predisposing condition such as diabetes is still present.
Contact Us
Dr. Peter Howard is an orthopedic surgeon specializing in shoulder surgery, sports medicine, and arthroscopy. Contact us for the next steps and to determine your treatment options.