Frozen shoulder syndrome, known medically as adhesive capsulitis, is a condition when the range of motion in the shoulder joint is so limited that it feels almost as if the shoulder is frozen in place. At the extreme end of this condition, patients are unable to move their shoulder at all. There may be shoulder pain as a result, and normal, daily activities may become impossible or painful to complete. Following a shoulder injury, care should be taken to help prevent the development of frozen shoulder syndrome. Here’s what you need to know.
What causes frozen shoulder syndrome?
The shoulder joint is a ball-and-socket joint that allows a full range of motion up and down and in a large circle. The head of the humerus – the upper arm bone – is the ball that fits into the shallow socket of the shoulder blade. Connective tissue called the shoulder capsule surrounds the entire joint, and movement is lubricated by synovial fluid.
Frozen shoulder syndrome has a variety of causes. If a person stops using their shoulder due to pain or injury, the shoulder will naturally become stiff from disuse. Chronic health conditions such as diabetes or stroke may also cause someone to stop using their shoulder.
Once the joint begins to stiffen (or as a normal response to injury), scar tissue may begin to develop in the shoulder capsule, effectively “freezing” the shoulder in place. The shoulder capsule comes inflamed and extremely painful to move.
Frozen shoulder syndrome occurs over a long period of time as movement in that joint slows or stops and scar tissue builds.
Symptoms of frozen shoulder syndrome
There are three stages to frozen shoulder syndrome, each of which has its own symptoms.
Stage 1: Freezing
As this stage begins, patients may experience increasing pain in their shoulder accompanied by decreasing range of motion. In response to the increased pain, patients may stop moving their shoulder as much, which only exacerbates the condition. This stage can last anywhere from six weeks to nine months.
Stage 2: Frozen
During this stage, patients may not experience much pain, but movement may become impossible. Range of motion is greatly diminished or disappears completely, even to lift the arm up a few inches. Daily life becomes challenging during the four weeks to six months of this stage.
Stage 3: Thawing
This recovery period of frozen shoulder syndrome can last anywhere from six months to two years, depending on the severity and amount of scar tissue built up. Shoulder range of motion is gradually restored to normal. Pain decreases substantially or is eliminated entirely once inflammation is under control.
The length of each stage depends greatly on treatment. For patients who do not see a doctor or begin treatment, frozen shoulder can persist far beyond what is necessary.
In some patients, pain may seem to increase during sleep. This may be an actual increase, or it may be due to the lack of other distractions. Frozen shoulder syndrome does not often reoccur in the same shoulder.
Diagnosing frozen shoulder syndrome
A thorough medical exam is the first step in the diagnosis of frozen shoulder syndrome. This includes medical history that focuses on previous injuries to the area or family history of any medical conditions that might place a patient at risk for frozen shoulder syndrome.
Doctors may utilize X-rays to look for damage to the dense structures of the shoulder (bones). They may also be able to identify solid masses or any previously undetected injury.
Magnetic resonance imaging (MRI) or ultrasound are two other ways in which doctors can identify inflammation and scar tissue in the shoulder capsule. This inflammation and scar tissue, when combined with pain and decreased range of motion, can help diagnose frozen shoulder syndrome.
Frozen shoulder syndrome occurs most often in people between the ages of 40 and 70. Other risk factors of frozen shoulder syndrome include:
- Gender: Women are more likely than men to have frozen shoulder syndrome.
- Injury or immobility: Any injury to the arm or shoulder that requires immobility for a period of time can lead to frozen shoulder syndrome. This includes rotator cuff injuries, broken arms, stroke, or recovery after surgery on the arm, hand, or shoulder itself.
- Disease: People with certain systemic diseases are at increased risk of developing frozen shoulder syndrome. These systemic diseases include diabetes, hyperthyroidism, hypothyroidism, cardiovascular disease, Parkinson’s disease, and tuberculosis. Doctors are not sure why these diseases put patients at risk. Diabetes in particular increases the risk, with ten to 20% of diabetes patients developing frozen shoulder syndrome at some point.
Treatments for frozen shoulder syndrome
As with many syndromes of this type, prevention is the best type of treatment. Knowing the risk factors is the first step. The second step is to remain active and keep exercising the shoulder joint if risk factors of any type are present.
Other treatments for frozen shoulder syndrome include:
- Non-steroidal anti-inflammatory drugs (NSAIDs): Over-the-counter non-steroidal anti-inflammatory drugs are a great short-term way to reduce pain-causing inflammation. This inflammation may discourage a patient from moving the shoulder joint, a decrease in activity that can only make the condition worse.
- Hot and cold therapy: Ice packs and heating pads applied alternatively may be able to reduce inflammation and increase range of motion.
- Stretching and exercise: Gentle, gradual exercise to increase the range of motion in the joint is a great treatment protocol that can be done at home. This helps loosen scar tissue and gradually restores the shoulder’s range of motion.
- Physical therapy: A physical therapist can help design an exercise plan to open up the shoulder joint.
- Steroid injections: Steroid injections will not cure frozen shoulder but can reduce inflammation and pain so that patients can begin to exercise to break up scar tissue.
- Surgery: There are two main surgeries associated with frozen shoulder syndrome. Manipulation is when a doctor places a patient under anesthesia so that they can physically move the arm in the socket to break up scar tissue. Arthroscopic capsular release involves cutting through tight tendons and tissues to release what’s holding the shoulder.
Preventing frozen shoulder syndrome through regular exercise and activity is the best course of action. Have you ever experienced this condition, and if so, what treatments were effective for you?