Frozen Shoulder

(Adhesive Capsulitis)

Definition

Frozen shoulder is a tightening of the tissue around the shoulder joint. It results in a loss of movement and pain at the shoulder joint.In frozen shoulder:
  • Active range of motion is lost—You cannot move your shoulder well.
  • Passive range of motion is lost—Someone trying to move your arm at the shoulder joint will find it stiff and difficult to move.
This condition may get worse over time. After a period of time, the shoulder may also improve spontaneously. This improvement is called thawing.

Causes

Frozen shoulder is caused by inflammation and scarring of the soft tissues of the shoulder. This includes the capsule that surrounds the joint.The cause of the tightening is usually not known.
Frozen Shoulder
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Risk Factors

Frozen shoulder is more likely to occur in women between the ages of 40-65 years old.Factors that increase your risk for frozen shoulder include:
  • Diabetes especially with complex regional pain syndrome
  • Thyroid problems
  • Disc problems in your neck
  • Injuries to the shoulder
  • Illness or injury that forces you to keep the shoulder immobile for a period of time
  • Heart and/or lung disease, during which time you do not move the shoulder normally

Symptoms

Symptoms include:
  • Painful shoulder
  • Much reduced movement of the arm at the shoulder joint

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. The range of motion in your shoulder will be tested.Images may be taken of your shoulder. This can be done with:

Treatment

Treatment focuses on:
  • Relieving pain
  • Restoring function and range of motion to the shoulder

Nonsurgical Options

  • Pain relief with nonsteroidal anti-inflammatory drugs—To help reduce inflammation and relieve pain.
  • Muscle relaxants—To help relax arm and shoulder muscles.
  • Physical therapy—To stretch muscles and restore motion and function to the shoulder. This is the foundation of treatment. It requires home exercise.
  • Heat and ice therapies—To help relieve pain and reduce swelling.
  • Corticosteroid injections—As prescribed and given by your doctor (rarely done for this condition).
  • Low-level laser therapy and pulsed electromagnetic field therapy—May have some benefit, but evidence is mixed. It may be used alone or with other therapies.
  • Extracorporeal shockwave therapy—To stimulate healing using shock waves outside of the body

Surgery

Closed ManipulationClosed manipulation surgery is a forceful movement of the arm at the shoulder joint. It is done to loosen the stiffness. The surgery is performed under anesthesia. The procedure is followed by intensive physical therapy. Arthroscopic SurgeryIn arthroscopic surgery, a small incision is made in the shoulder. Special small instruments are inserted through the incision. The tightened tissues are released. The shoulder is manipulated. Physical therapy must be done after this procedure.

Capsular Distension

Capsular distension is often done as a combination of an arthrogram and corticosteroid injection. The doctor expands the shoulder joint by injecting salt water under pressure. The fluid may contain cortisone and may also contain a dye that allows the shape and character of the shoulder joint to be seen.

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Prevention

Frozen shoulder may recur. To help prevent frozen shoulder:
  • Do regular strength training and range-of-motion exercises. This will help maintain a strong and flexible shoulder joint.
  • Seek prompt treatment for a shoulder injury.
  • Do activities that use your shoulder joint regularly.
  • After injury to an upper extremity (such as, hand, wrist, elbow), always move the shoulder through a full range of motion several times a day. This is true even when lying in bed for an illness such as a lung infection.

RESOURCES

American Academy of Orthopaedic Surgeons
http://orthoinfo.aaos.org

American Orthopaedic Society for Sports Medicine
http://www.sportsmed.org

CANADIAN RESOURCES

Canadian Orthopaedic Association
http://www.coa-aco.org

Canadian Orthopaedic Foundation
http://www.canorth.org

References

Adhesive capsulitis of shoulder. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated June 6, 2014. Accessed September 29, 2014.

Ewald A. Adhesive capsulitis: a review. Am Fam Physician. 2011 Feb 15;83(4):417-422.

Garcilazo C, Cavallasca JA, et al. Shoulder manifestations of diabetes mellitus. Curr Diabetes Rev. 2010 Sep;6(5):334-340.

Neviaser AS, Hannafin JA. Adhesive capsulitis: a review of current treatment. Am J Sports Med. 2010 Nov;38(11):2346-2356.

Woodward TW, Best TM.The painful shoulder part I: clinical evaluation. Am Fam Physician. 2000;61(10):3079-3088.

Woodward TW, Best TM. The painful shoulder part II: acute and chronic disorders. Am Fam Physician. 2000;61(11):3291-3300.

5/7/2014 DynaMed Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Kelley MJ, Shaffer MA, et al. Shoulder pain and mobility deficits: adhesive capsulitis. J Orthop Sports Phys Ther. 2013 May;43(5):A1-31.

11/6/2014 DynaMed Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Page MJ, Green S, et al. Electrotherapy modalities for adhesive capsulitis (frozen shoulder). Cochrane Database Syst Rev. 2014;10:CD011324.

1/21/2015 DynaMed Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Chen CY, Hu CC, et al. Extracorporeal shockwave therapy improves short-term functional outcomes of shoulder adhesive capsulitis. J Shoulder Elbow Surgery. 2014 Dec;23(12):1843-1851.

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