Frozen Shoulder
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Frozen Shoulder

(Adhesive Capsulitis)

En Español (Spanish Version)

Definition

Frozen shoulder is a condition that results in a loss of movement and pain at the shoulder joint.

In frozen shoulder:

  • Active range of motion is lost.—This means you cannot move your shoulder well.
  • Passive range of motion is lost.—This means another person trying to move your arm at the shoulder joint will find it stiff and difficult to move.

Frozen shoulder gets worse over time. However, after a period of time, the shoulder may improve spontaneously. This improvement in mobility is called thawing.

Causes

Frozen shoulder is caused by tightening of the soft tissues, such as the capsule, that surround the shoulder joint.

Frozen Shoulder

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Risk Factors

A risk factor is something that increases your chance of getting a disease, injury, or condition. Risk factors for frozen shoulder include:

  • Diabetes
  • 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

Symptoms

Symptoms include:

  • Painful shoulder
  • Inability to move the arm at the shoulder joint, either by yourself or by someone else

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. The doctor will test the range of motion in your shoulder.

Tests may include:

  • X-rays—a test that uses radiation to take pictures of structures inside the body, to rule out other possible causes of the stiffness
  • MRI scan—a test that uses magnetic radiation waves to make pictures of the tissues in the body, used to examine the soft tissues around the shoulder
  • Arthrograms—x-ray pictures taken after dye is injected into the shoulder area. This test is difficult to perform with this shoulder condition.

Treatment

Treatment focuses on relieving pain and restoring function and range of motion to the shoulder.

Nonsurgical Options

  • Pain relievers (eg, ibuprofen [Advil, Motrin] and aspirin)—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, which requires much home exercise under the direction of a physical therapist.
  • 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)

Surgery

Surgery is an option if there is no improvement after 4 to 6 months of intensive therapy. Surgeries include:

  • Closed manipulation—This involves forceful movement of the arm at the shoulder joint to loosen the stiffness. This is performed under anesthesia and followed by intensive physical therapy.
  • Arthroscopic surgery—An arthroscope, which is a long, thin, fiberoptic tube with a light on the end, is inserted through a small incision in the shoulder. Using this tube and other small instruments, the tightened tissues are released and the shoulder is manipulated. Physical therapy must be done after this surgery.

Prevention

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 any injury to the upper extremity (hand, wrist, elbow, etc), 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://www.aaos.org

American Orthopaedic Society for Sports Medicine
http://www.aossm.org/tabs/Index.aspx

CANADIAN RESOURCES:

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

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

References:

Cecil Textbook of Medicine . 21st ed. WB Saunders Company; 2000.

Campbell's Operative Orthopaedics . 9th ed. Mosby, Inc; 1998.

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

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



Last reviewed October 2007 by Robert E. Leach, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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