Many patients suffer from "frozen shoulder" which physicians refer to as adhesive capsulitis, or on occasion, bursitis or tendonitis. This is a rather unusual problem that occurs in the shoulder and results in stiffness, loss of motion and often substantial pain.
The causes of a frozen shoulder are unknown. However, it is well known that it does not occur in any other joint in the body. Although the process is often self limited, the problem of a frozen shoulder occurs in 3 phases. Each phase is approximately 4 months in length. Initially, a "freezing phase" occurs. This is followed by a "frozen phase" and is completed by a "thawing phase". The entire time frame of a frozen shoulder may last as long as a year. While it is extremely rare for this problem to last longer than a year, it may last as long as 3 years, causing stiffness and discomfort for that period of time. Fortunately, it is very rare for the disorder to recur. Surprisingly, the non dominant shoulder is affected more than the dominant one. This disorder usually occurs between the ages of 40 and 60 and 70% of the cases occur in women. It is not normally associated with calcium deposits or rotator cuff injuries, and often x-rays are completely normal.
Fortunately, a frozen shoulder is not often associated with arthritis or malignancies. However, there may be some association with thyroid disease, diabetes and other diseases. A thorough work-up for any disorder may be necessary if a frozen shoulder occurs.
Many times patients will describe their shoulder as becoming increasingly stiff and painful over a period of time. This often occurs in middle aged women and may be related to either a minor injury, some form of stress, or bed rest following illness. Initially pain may occur with activities, as well as at rest. This often prevents sleep or may cause considerable pain during sleep with difficulty in finding a comfortable position in bed. Pain is progressive over a period of weeks and often results in loss of motion in the shoulder as the patient attempts to limit the pain by voluntarily decreasing the amount of motion in the shoulder. Many people are able to retain enough motion to allow for some function. However, the loss of motion with respect to raising and rotation of the arm often significantly limits the activities of daily living including such simple actions as placing the arm behind the back or tucking in a shirt.
Treatment is generally based on the time period when the patient reports to the office. Patients who are first seen in the "freezing stage" or when the shoulder becomes frozen are very difficult to treat because this phase is very resistant to the standard methods of treatment including physical therapy, injections, and medication. Patients become frustrated because they do not realize that the "freezing phase" usually lasts about four months and is often resistant to treatment.
However, the period of time when the shoulder is actually frozen or quite stiff, which is usually 3-4 months after the shoulder becomes painful and progressively loses motion, is often amenable to treatment. The methods of treatment include physical therapy, medication and nerve blocks. The "thawing phase", which is approximately 3-4 months following the "frozen phase", and a total of six months after the initial problem starts, is the time when therapy is most important and can often greatly improve the motion and use of the shoulder. Other treatments such as manipulating the shoulder and arthroscopy may be necessary. These treatments aid in treating the frozen shoulder since they may allow for an earlier recovery by stretching out the capsule which has tightened in the shoulder and consequently results in diminished motion in the shoulder. Surgical treatment such as manipulating the shoulder, or even arthroscopy, should be approached with substantial caution since the frozen shoulder itself is often a self limiting process. Overly aggressive surgical treatment may cause more problems than a non-operative program of icing, medication and therapy.
The frozen shoulder is a curious and perplexing problem that often causes substantial frustration for patients, therapists and physicians. Fortunately, it is a self limited process and often improves with the tincture of time and conservative treatment.
THIS MATERIAL DOES NOT CONSTITUTE MEDICAL ADVICE. IT IS INTENDED FOR INFORMATIONAL PURPOSES ONLY. PLEASE CONSULT A PHYSICIAN FOR SPECIFIC TREATMENT RECOMMENDATIONS.
THE CENTER FOR ORTHOPAEDICS AND SPORTS MEDICINE
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