Frozen shoulder, also known as adhesive capsulitis, causes pain, stiffness, and decreased range of motion at the shoulder joint, leading to difficulty in performing the activities of daily living (ADL) and other various functions. Once diagnosed, there are conservative ways to treat and heal it quickly. An injection may be needed, or anesthesia required for a surgical procedure.
In frozen shoulder (also known as adhesive capsulitis), the joint capsule becomes inflamed, causing limited range of motion and pain with shoulder movement.
The cause of frozen shoulder is unknown, but it is commonly associated with diabetes, thyroid disorders, and cardiovascular issues.
The treatment for frozen shoulder can be conservative, such as medications or physical therapy, while in other instances, more aggressive treatments like injections or surgical procedures are needed.
Anatomy of frozen shoulder
The picture below illustrates how inflammation of the joint capsule, the fluid-filled sac that lubricates the shoulder joint, results in a frozen shoulder; it causes pain and restricted range of motion. The shoulder joint is a ball-and-socket joint with the humerus (upper arm bone) joining with the scapula (shoulder bone).
Causes of frozen shoulder
Even though the exact cause of frozen shoulder is unknown, anything that causes inflammation or thickening of the joint capsule can lead to a frozen shoulder. However, conditions commonly associated with frozen shoulder include diabetes, thyroid disorder, cardiovascular disease, and previous shoulder injury.
Frozen shoulder occurs more often in women than men, and the non-dominant shoulder is usually more frequently affected. The most commonly affected age range is 40–60.
Symptoms of frozen shoulder
The most common symptom is shoulder pain that occurs at night and usually interferes with sleep. In addition, there can be stiffness and a limited range of motion. With the limited range of motion, everyday activities such as getting dressed or reaching for high objects can be affected.
Diagnosis of frozen shoulder
There are several ways to diagnose frozen shoulder, including:
The patient's history will typically elicit the symptoms mentioned above.
The results of the physical examination are crucial, but it is challenging to perform a thorough shoulder exam because of the pain and stiffness. A frozen shoulder occurs when an external force, such as a machine or therapist, leads to decreased movement at the joint, referred to as a reduced passive range of motion. As opposed to this, active range of motion occurs when a person moves a joint on their own.
Imaging studies and tests
Here are some common tests and imaging studies applied when diagnosing a frozen shoulder:
- Plain X-rays. This method is used to rule out any underlying bony abnormalities such as fractures, tumors, cysts, arthritic changes, or bone thinning (osteoporosis).
- A computerized tomography (CT or CAT) or magnetic resonance imaging (MRI) scan. These methods should be used to view the underlying soft tissue structures, such as muscles, tendons, ligaments, and cartilage. These scans allow three-dimensional viewing of the underlying structures and could help identify if a rotator cuff tear is present.
- Ultrasound. This method uses sound waves to view the underlying soft tissue structures. It has emerged as a useful test to diagnose frozen shoulders since it shows certain diagnostic findings, including thickening of the shoulder pulleys.
- Laboratory tests. Your doctor may order laboratory tests, such as diabetes, thyroid, and cardiovascular lab tests, to rule out underlying illnesses.
- Electrocardiogram (EKG) or an echocardiogram (ECHO). An ultrasound of the heart. These tests are used to rule out cardiovascular disease.
Treatment of frozen shoulder
The treatment options of frozen shoulders include:
Medications and pain management
To help with inflammation and pain relief, non-steroidal anti-inflammatory drugs (NSAIDs) can be prescribed or taken at a high enough over-the-counter dose. Prescription anti-inflammatory drugs include, for example, Voltaren (diclofenac), Motrin (ibuprofen), Naprosyn (naproxen), and Celebrex.
NSAIDs should be used with caution because they can cause gastrointestinal side effects like gastritis and ulcers. Even though evidence for NSAIDs helping frozen shoulders is limited, they have been shown to help with short-term pain relief. In severe cases, opioid medications may be needed for pain relief, especially at night.
For treating frozen shoulder, physical therapy is one of the most effective options. Physical therapists can help with gentle stretching to increase mobility. Among the useful modalities are electrical stimulation and ultrasound.
For the treatment of stiffness and inflammation, use heat and ice therapy. To increase range of motion, daily practice at home can be facilitated by following exercise instructions.
If after six months of conservative treatment there is little to no improvement, more aggressive treatments like injections and surgery need to be explored.
- Injections. Cortisone injections directly into the joint can provide relief for a frozen shoulder. Saline can also be injected into the joint capsule through a procedure known as capsular hydrodilation, where the pressure of the saline causes the joint capsule to stretch.
- Surgical procedures. It is possible to physically tear the contracted capsule during joint capsule manipulation while under anesthesia. By using a scope, in arthroscopic capsular release, incisions are made through the constricted capsule to facilitate movement.
The average recovery period is 30 months, but it can take anywhere from 1 to 3.5 years. Within five years, 15% of patients experience problems with the opposing shoulder. In order to stop the symptoms of frozen shoulder from returning, physical therapy is crucial.
In addition to treating frozen shoulder, certain lifestyle changes can stop the illness from getting worse. Among them are routine workouts that strengthen and stretch the shoulders to improve joint mobility. Furthermore, managing underlying illnesses such as diabetes, thyroid problems, and cardiovascular diseases can help lower the chance of developing a frozen shoulder in the future.
In summary, a frozen shoulder can significantly impact the activities of daily living (ADL) for affected patients. However, a prompt diagnosis combined with conservative care or surgery can result in return to full function.
- Mayo Clinic. Frozen shoulder.
- StatPearls. Frozen Shoulder.
- Fronteirs in Medicine. A Comprehensive View of Frozen Shoulder: A Mystery Syndrome.
- National Library of Medicine. Ultrasound Features of Adhesive Capsulitis.