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Frozen shoulder is the common name for adhesive capsulitis, which is a shoulder condition that limits your range of motion. When the tissues in your shoulder joint become thicker and tighter, scar tissue develops over time. As a result, your shoulder joint doesn’t have enough space to rotate properly. Common symptoms include swelling, pain, and stiffness. You’re more likely to have the condition if you’re between the ages of 40 and 60.
You become aware of a frozen shoulder when it begins to hurt. The pain then causes you to limit your movement. Moving the shoulder less and less increases its stiffness. Before long, you find that you can’t move your shoulder as you once did. Reaching for an item on a high shelf becomes difficult, if not impossible. When it’s severe, you might not be able to do everyday tasks that involve shoulder movement such as dressing.
If you have a hormonal imbalance, diabetes, or a weakened immune system, you may be prone to joint inflammation. A long period of inactivity due to an injury, illness, or surgery also makes you more vulnerable to inflammation and adhesions, which are bands of stiff tissue. In serious cases, scar tissue may form. This severely limits your range of motion. Usually, the condition takes two to nine months to develop.
The condition is more likely to occur in middle age and is more common in women.
If you have diabetes, your risk for the condition is three times greater.
Others at risk include:
If you feel stiffness and pain in your shoulder, see your doctor. A physical exam will help to assess your range of motion. Your doctor will observe as you perform specific movements and measure range of motion of the shoulder, such as touching your opposite shoulder with your hand.
A few tests may also be necessary. Your doctor might do a magnetic resonance imaging scan (MRI) to rule out a tear in your rotator cuff or other pathology. X-rays may also be taken to check for arthritis or other abnormalities. You may need an arthrogram for the X-ray, which involves injecting dye into your shoulder joint so that the doctor can see its structure.
You can leave a frozen shoulder untreated, but the pain and stiffness can remain for up to three years. A combination of the following can speed up your recovery:
Physical therapy is the most common treatment for a frozen shoulder. The goal is to stretch your shoulder joint and regain the lost motion. It can take anywhere from a few weeks to nine months to see progress. A home exercise program of gentle range of motion exercises is important. If you don't see progress after six months of intense, daily exercises, speak to your doctor about other options.
To treat the pain and reduce your joint inflammation, your doctor may recommend an anti- inflammatory medication like aspirin, ibuprofen, or naproxen sodium. A steroid injection you’re your shoulder joint may also help.
Placing an ice pack on your shoulder for 15 minutes at a time several times per day can help to decrease pain. If you’re working with a physical therapist, the exercises can be done at home. Your physical therapist will provide instructions on the types of exercises you must do, how often to do them, and when to push yourself harder. Most people with a frozen shoulder can improve their condition without surgery.
If physical therapy doesn’t improve your condition, surgery is an option. From a surgical standpoint, your options are to manipulate the shoulder and put it through a full range of motion under a general anesthetic to help break up any adhesions. Another option is arthroscopic surgery. This type of surgery involves making a small cut in your shoulder and using a camera called an "arthroscope" to remove scar tissue or release it. This allows the shoulder to recover its lost motion. If your frozen shoulder is the result of an injury, surgery is usually more successful if it’s performed within a few weeks of the injury.
Surgery is usually done on an outpatient basis. Your stitches will most likely be removed after 10 days. Postoperative physical therapy is usually required as well. Many patients have their full range of motion back within three months.
Surgery carries risks, so talk with your doctor before deciding on any procedure. Some people still have pain or stiffness afterward or can’t handle the pain of physical therapy.
Most people recover within two years without treatment. Physical therapy and pain medications speed up this progress. If you have surgery, it’s important to continue the therapy exercises in the following months so that the problem doesn’t return.
Early treatment helps keep the condition from getting worse. If you have diabetes, properly managing it can reduce your risk for a frozen shoulder.
Written by: Chitra Badii and Winnie Yu
Medically reviewed on: Jan 11, 2016: William A Morrison, MD
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