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Stretching exercises, as well as the injection of corticosteroids and numbing medications into the joint capsule, are some of the treatments for frozen shoulder.  A very small percentage of cases may need surgery to loosen the joint capsule so it can move more freely.

 

 

Symptoms

 

Frozen shoulder typically develops slowly in three stages.  Each of these stages can last a number of months.

 

1. Painful stage.  Pain occurs with any movement of your shoulder and your shoulder's range of motion starts to become limited during this stage.

2. Frozen stage.  Pain may begin to diminish during this stage.  However, your range of motion decreases notably and your shoulder becomes stiffer.

3. Thawing stage.  During the thawing stage, the range of motion in your shoulder begins to improve.

 

For some people, pain worsens at night, sometimes disrupting normal sleep patterns.

 

 

Causes

 

Your shoulder joint is made of bones, ligaments and tendons that are encased in a capsule of connective tissue.  When this capsule thickens and tightens around the shoulder joint, restricting its movement, frozen shoulder occurs.

 

Doctors are not really sure why this happens to some people and not to others.  It is more likely to occur in people who have recently experienced prolonged immobilization of their shoulder, such as after surgery or an arm fracture.

 

 

Risk Factors

 

Although the exact cause is unknown, there are certain factors that may increase your risk of developing frozen shoulder such as:

 

• Age and sex.  People 40 and older are more likely to experience frozen shoulder.  Also, the majority of people who develop this condition are women.

• Immobility or reduced mobility.  People who have experienced prolonged immobility from rotator cuff injuries, a broken arm, stroke, or recovering from surgery, are at a higher risk of developing frozen shoulder.

• Systemic diseases.  Certain medical problems appear to be predispose people to developing frozen shoulder such as diabetes, overactive thyroid (hyperthyroidism), underactive thyroid (hypothyroidism), cardiovascular disease, tuberculosis, and parkinson's disease.

 

 

Tests and Diagnosis

 

During a physical exam, your doctor may ask you to perform a variety of actions to check for pain and evaluate your range of motion.  These may include:

 

• Hands up.  Raise both your hands straight up in the air, like a football referee calling a touchdown.

• Opposite shoulder.  Reach across your chest to touch your opposite shoulder.

• Back scratch.  Starting with the back of your hand against the small of your back, reach upward to touch your opposite shoulder blade.

 

In order to help distinguish between frozen shoulder and a rotator cuff injury, your doctor may ask you to relax your muscles while he or she moves your arm for you.

 

Although signs and symptoms alone can usually diagnose frozen shoulder, your doctor may suggest imaging tests such as X-rays or an MRI to rule out other structural problems.

 

 

Treatments and drugs

 

Most of the treatments for frozen shoulder involve controlling the pain it causes and preserving as much range of motion in the shoulder as possible.

 

 

Medications

 

Over-the-counter pain relievers, such as ibuprofen (Advil, Motrin & others), can help reduce pain and inflammation associated with frozen shoulder.  In some cases, your doctor may prescribe stronger pain-relieving and anti-inflammatory drugs.

 

Therapy

 

Stretching exercises provided by a physical therapist can help maintain mobility in your shoulder.

 

Surgical and other procedures

 

Most frozen shoulders get better on their own within 12 to 18 months.  If you have persistent symptoms, your doctor may suggest:

 

• Steroid injections.  Corticosteroids injected into your shoulder joint may help decrease pain and improve the mobility of your shoulder.

• Joint distension.  Injecting sterile water into the joint capsule can help stretch the tissue and make it easier to move the joint.

• Shoulder manipulation.  In this procedure, you receive a general anesthetic so you'll be unconscious and feel no pain.  The doctor then moves your shoulder joint in different directions to help loosen the tightened tissue.  This procedure can cause bone fractures, depending on the amount of force used.

• Surgery.  If nothing else has helped, you may be a candidate for surgery to remove scar tissue and adhesions from inside your shoulder joint.  This surgery is usually performed arthroscopically, with lighted, tubular instruments inserted through small incisions around your joint.

 

 

Lifestyle 

 

Consult with your physician regarding what activity is recommended.  Typically, you may continue to use the involved shoulder and extremity in as many daily activities as possible, within the limits of your pain and range-of-motion constraints.  

 

 

Prevention

 

One of the most common causes of frozen shoulder is the immobility that may result during recovery from a shoulder injury, broken arm, or a stroke.  Talk to your doctor about what exercises would be best to maintain the range of motion in your shoulder joint, if you have had an injury that makes it difficult to move your shoulder.

 

 

For more information about simple, safe, and effective treatments for Frozen Shoulder, or any other conditions of the hands or upper extremities, schedule an appointment with Dr. Sagini by calling 239-337-2003.