Frozen shoulder

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Shoulder joint inflammation

Definition

Frozen shoulder is when the shoulder is painful and cannot move normally because of inflammation.

Alternative Names

Adhesive capsulitis

Causes, incidence, and risk factors

The joint capsule of the shoulder joint has ligaments that hold the shoulder bones to each other. When the capsule becomes inflamed, the shoulder bones are unable to move freely in the joint.

Most of the time there is no cause for the inflammation. However, inflammation may be caused by:

• Cervical disk disease of the neck
• Diabetes
• Shoulder trauma
• Shoulder surgery
• Open heart surgery
• Hyperthyroidism

Symptoms

The main symptoms are:

• Decreased motion of the shoulder
• Pain
• Stiffness

Frozen shoulder without any known cause starts with pain. This pain prevents you from moving your arm. The lack of movement leads to stiffness and decreased motion. Eventually you cannot perform activities such as reaching over your head.

Signs and tests

The health care provider will make the diagnosis based on your symptoms and an examination of your shoulder.

You may have x-rays of the shoulder to make sure there is no other problem, such as arthritis. Sometimes an MRI exam may show inflammation, but there are no specific findings that diagnose frozen shoulder.

Treatment

Pain is treated with nonsteroidal anti-inflammatory medications (NSAIDs) and steroid injections. Steroid injections along with physical therapy can significantly improve motion. It can take as long as 6 - 9 months to see improvement. The physical therapy is intense and needs to be done every day.

Any risk factors for frozen shoulder may also need to be treated.

Surgery is recommended if therapy is not successful. Your health care provider will release the scar tissue by bringing the shoulder through a full range of motion. This procedure is done under anesthesia.

Arthroscopic surgery can be used to cut the tight ligaments and remove the scar tissue from the shoulder. Some surgeons may use repeated pain blocks after surgery so you can participate in physical therapy.

Expectations (prognosis)

Treatment with therapy and NSAIDs will usually return the motion and function of the shoulder within a year. Even if left untreated, the frozen shoulder can get better by itself in 18 - 24 months.

Even if surgery restores motion, you must continue physical therapy for several weeks or months afterward to prevent the frozen shoulder from returning. Treatment may fail if you cannot tolerate physical therapy.

Complications

• Stiffness and pain continue even with therapy
• The arm can break if the shoulder is moved forcefully during surgery

Calling your health care provider

If you have shoulder pain and stiffness and suspect you may have a frozen shoulder, contact your health care provider for proper referral and treatment.

Prevention

The best way to prevent frozen shoulder is to contact your health care provider if you develop shoulder pain that limits your range of motion for an extended period of time. This will allow early treatment and help avoid stiffness.

People who have diabetes will be less likely to get frozen shoulder if they keep their condition under control.

References

Miller RH, Dlabach JA. Shoulder and elbow injuries. In: Canale ST, Beatty JH, eds. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, Pa: Mosby Elsevier;2007:chap 44.

Krabak BJ, Banks NL. Adhesive capsulitis. In: Frontera WR, Silver JK, eds. Essentials of Physical Medicine and Rehabilitation. 2nd ed. Philadelphia, Pa: Saunders Elsevier;2008:chap 10.

Review Date: 2/3/2009

Reviewed by: Linda Vorvick, MD, Family Physician, Seattle Site Coordinator, Lecturer, Pathophysiology, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine; and C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Dept. of Orthopaedic Surgery. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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