Frozen Shoulder

FROZEN SHOULDER
What’s Frozen Shoulder?
It’s pain and stiffness in your shoulder

that happens slowly. It can worsen until
your shoulder seems “frozen” in one
position. Your doctor might call it
“adhesive capsulitis.” Although it may
take as much as a few years to get
completely better, it can improve long
before then, especially if you do physical
therapy to help with recovery.
Causes
Doctors don’t know exactly what causes it, though
some things make you more likely to have it. For
example, it can happen if you can’t move your
shoulder very well because of an injury or surgery,
or if you have diabetes, which can worsen
symptoms and make them last longer. Thyroid
problems, Parkinson’s disease, heart disease, and
certain HIV medications also seem to raise your
odds of getting frozen shoulder.
What Happens
Strong connective tissue called the shoulder
capsule surrounds the ball end of your upper
arm bone and holds it to the socket. Frozen
shoulder causes this tissue to get thicker in
parts (adhesions) and inflamed. This may limit
the “synovial” fluid that normally lubricates the
area and prevents rubbing. The result is pain
and stiffness. There are three stages.
Stage 1: Freezing
Over a period of 2 to 9 months, the shoulder
capsule gets more and more inflamed. This
ramps up pain and stiffness, and starts to limit
your range of motion (how well you can use
the joint). And these symptoms often get worse
at night.
Stage 2: Frozen
As you might have guessed, this is when your
shoulder is stiffest and hardest to move. It
usually lasts somewhere between 4 months and
a year. Pain often starts to improve in this
stage. But your range of motion may be so
limited that you find it hard to do basic things
like eat, dress, and go to the bathroom.
Stage 3: Thawing
Your shoulder pain should continue to ease
during this stage, and now you start to regain
some of your range of motion, too. It happens
slowly, taking 6 months to 2 years. In some
cases, you may get back all or almost all of
your strength and mobility.
Who Gets It?
It’s most common if you’re in your 50s or 60s,
and it’s rare for anyone under 40. Women get it
more than men. And if you get frozen shoulder
on one side of your body, you’re up to 30%
more likely to get it on the other side.
Physical Exam
Your doctor will ask you about your symptoms,
injuries, and medical history. Then she’ll check
your shoulder. She’ll move it herself to see
where the pain and stiffness start. This is your
passive range of motion. Then she’ll ask you to
move it yourself. That’s your active range of
motion. At the limit, it may feel like your arm
is stuck. If you have frozen shoulder, your
passive and active range of motion will be less
than normal.
Tests
An “injection test” may help narrow down the
cause of your symptoms. Your doctor gives you
a shot in your arm that dulls the pain. With
most shoulder problems, this gives you a bigger
range of motion, but it won’t change it much if
you have frozen shoulder. Doctors typically
only use imaging tests like X-rays, ultrasounds,
and MRIs to rule out other conditions.
Exercises
Once your frozen shoulder pain starts to ease
up, your doctor might suggest arm exercises. A
physical therapist can give you moves to do as
homework. Take it easy at first. If you “push
through the pain,” you could make things
worse. You’ll likely start with range-of-motion
exercises for a couple of months. After you feel
better, you can safely begin to build strength.
Medicine
NSAIDs (non-steroidal anti-inflammatory
drugs) like aspirin, ibuprofen, and naproxen
may curb pain and swelling. More powerful
drugs called steroids are sometimes injected
directly into the joint. But it can be tricky to get
them into just the right spot, and even these
will only provide temporary relief of your
symptoms.
Hydrodilatation
Your doctor might suggest this method if
physical therapy and medication haven’t
helped. She’ll use pictures of the inside of your
body to guide a shot of fluid into your shoulder
joint. The goal is to stretch out the joint capsule
and give you better range of motion.
Surgery
Your doctor may suggest this, usually in the
“frozen” stage, if nothing else works. There are
two methods, sometimes used together. The
first is manipulation while you’re “asleep”
from general anesthesia. The surgeon moves
the joint until it stretches or even tears the
tissue. The second method, called arthroscopy,
cuts the affected tissue directly. Your surgeon
works through small cuts in your skin, using
special tools.
Recovery
Frozen shoulder gets better for a lot of people
within a year if they do physical therapy and
use pain medicines and steroid shots if needed.
Even without those methods, most people get
better within a couple of years, though if you
have diabetes, it may be harder to recover.
Surgery works pretty well as long as you stick
with your physical therapy afterward to rebuild
and keep up your strength and mobility.

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FROZEN SHOULDER

What’s Frozen Shoulder?

It’s pain and stiffness in your shoulder

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