Frozen shoulder

  • Definition
    • Frozen shoulder is a condition in which the shoulder is painful and loses motion because of inflammation.

  • Alternative Names
    • Adhesive capsulitis

  • Causes
    • The capsule of the shoulder joint has ligaments that hold the shoulder bones to each other. When the capsule becomes inflamed, the shoulder bones are unable to move freely in the joint.

      Most of the time, there is no cause for frozen shoulder. Risk factors include:

  • Symptoms
    • Main symptoms of a frozen shoulder are:

      • Decreased motion of the shoulder
      • Pain
      • Stiffness

      Frozen shoulder without any known cause starts with pain. This pain prevents you from moving your arm. This lack of movement can lead to stiffness and even less motion. Over time, you are not able to do movements such as reaching over your head or behind you.

  • Exams and Tests
    • Your health care provider will ask about your symptoms and examine your shoulder. A diagnosis is often made when you are not able to rotate your shoulder.

      You may have x-rays of the shoulder. This is to make sure there is no other problem, such as arthritis. Sometimes an MRI exam shows inflammation, but imaging tests do not show specific signs to diagnose frozen shoulder.

  • Treatment
    • Pain is treated with nonsteroidal anti-inflammatory medications (NSAIDs) and steroid injections. Steroid injections and physical therapy can improve your motion.

      It can take a few weeks to see progress. It may take as long as 6 to 9 months for complete recovery. Physical therapy is intense and needs to be done every day.

      Left untreated, the condition often gets better by itself within 2 years with little loss of motion.

      Risk factors for frozen shoulder, such as diabetes or thyroid problems, should also be treated.

      Surgery is recommended if nonsurgical treatment is not effective. This procedure (shoulder arthroscopy) is done under anesthesia. During surgery the scar tissue is released (cut) by bringing the shoulder through a full range of motion. Arthroscopic surgery can also be used to cut the tight ligaments and remove the scar tissue from the shoulder. After surgery, you may receive pain blocks (shots) so you can do physical therapy.

  • Outlook (Prognosis)
    • Treatment with physical therapy and NSAIDs often restores motion and function of the shoulder within a year. Even untreated, the shoulder may get better by itself in 2 years.

      After surgery restores motion, you must continue physical therapy for several weeks or months. This is to prevent the frozen shoulder from returning. If you do not keep up with physical therapy, the frozen shoulder may come back.

  • Possible Complications
    • Complications may include:

      • Stiffness and pain continue even with therapy
      • The arm can break if the shoulder is moved forcefully during surgery
  • When to Contact a Medical Professional
    • If you have shoulder pain and stiffness and think you have a frozen shoulder, contact your health care provider for referral and treatment.

  • Prevention
    • Early treatment may help prevent stiffness. Call your provider if you develop shoulder pain that limits your range of motion for an extended period.

      People who have diabetes or thyroid problems will be less likely to get frozen shoulder if they keep their condition under control.

  • References
    • Getz CL, Phillips J. Adhesive capsulitis. In: Skirven TM, Osterman AL, Fedorczyk JM, Adadio PC. Rehabilitation of the Hand and Upper Extremity. 6th ed. Philadelphia, PA: Elsevier Mosby; 2011:chap 89.

      Harris JD, Griesser MJ, Jones GL. Stiff shoulder. In: Miller MD, Thompson SR, eds. DeLee and Drez's Orthopaedic Sports Medicine: Principles and Practice. 4th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 55.

      Kelley MJ, Shaffer MA, Kuhn JE, Michener LA, Seitz AL, et al, eds. Shoulder pain and mobility deficits: adhesive capsulitis. J Orthop Sports Phys Ther. 2013;43:A1-A31. PMID 23636125

      Miller RH, Azar FM, Throckmorton TW. Shoulder injuries. In: Canale ST, Beaty JH, eds. Campbell's Operative Orthopaedics. 12th ed. Philadelphia, PA: Elsevier Mosby; 2012:chap 46.