Frozen shoulder, also known as adhesive capsulitis, causes stiffness and pain in your shoulder joint. What happens is the membrane that surrounds the shoulder joint (the joint capsule) begins to thicken and stiffen. The bones, ligaments, and tendons that make up your shoulder joint are encased in this capsule of connective tissue.
Pain and immobility usually start slowly and get progressively worse as the capsule becomes severely inflamed. The membrane can develop adhesions which further constrict the smooth movement of the joint, tendons, and ligaments. The term “frozen” shoulder is used because as the pain worsens, the less you want to move your shoulder and the more constricted and tighter it becomes.
Symptoms
Frozen shoulder is common and often follows this three-stage pattern. The pain is sometimes described as a “dull ache” or “deep-seated.” It can also spread into the biceps. It becomes increasingly difficult to lift your arm up or move it backwards. X-rays can look normal.
- Freezing stage. Any movement of your shoulder causes pain, and your shoulder’s range of motion starts to become limited.
- Frozen stage. Pain may begin to diminish during this stage. However, your shoulder becomes stiffer, and using it becomes more difficult.
- Thawing stage. The range of motion in your shoulder begins to improve.
For some people, the pain worsens at night, sometimes disrupting sleep.
Diagnosis
- Your health care provider will first get your complete medical history, examination and X-rays, to rule out other potential causes of a painful shoulder or limited shoulder motion such as arthritis, or calcium deposits.
- Your provider will have you move your arm and shoulder in all directions, called “active motion” to determine your current range of motion and pain level.
- Your provider will also move your arm and shoulder for you to determine your “passive range of motion.”
- People with frozen shoulder have limited range of both active and passive motion.
Causes and Risk Factors
Certain factors may increase your risk of developing frozen shoulder:
- Posture plays a role – hunching over a laptop can increase the risk
- People 40 and older, particularly women, are more likely to have frozen shoulder.
- Though there is no direct correlation with menopause, some experts believe that the reduction in collagen that occurs as estrogen levels decline might contribute
- If you’re recovering from a medical condition or procedure that prevents you from moving your arm, such as:
- stroke
- arm fracture
- mastectomy– swelling after an injury can also contribute to the condition.
- rotator cuff injury
- Recovery from surgery such as mastectomy
- Frozen shoulder is more likely to occur in people who have diabetes.
- Immobility or reduced mobility; those who are sedentary and seldom perform range of motion or stretching activities.
People who have certain diseases appear more likely to develop frozen shoulder. Diseases that might increase risk include:
- Diabetes
- Overactive thyroid (hyperthyroidism)
- Underactive thyroid (hypothyroidism)
- Cardiovascular disease
- Tuberculosis
- Parkinson’s disease
Treatment
Physical therapy is usually the first line of treatment. Range of motion, stretching and strengthening exercises can slowly improve the condition. The therapist may also use ice, heat, ultrasound, or electrical stimulation. This recovery requires lots of patience! It may take from one to three years to fully recover from frozen shoulder. It takes determination to stick to a therapeutic exercise routine – but this is the road to recovery. Anti-inflammatory medication, NSAIDS (ibuprofen, Advil) and steroidal injections are sometimes prescribed.
In a small percentage of cases, arthroscopic surgery may be indicated to loosen the joint capsule so that it can move more freely.
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