The shoulder is the most mobile joint in the human body. The shoulder joint is made up of the ball end of the upper arm bone that fits into the socket of the collar bone (clavicle) and the shoulder blade (scapula). The two bones are held in place by ligaments, tendons and muscles.
This arrangement allows a great range of movement -- but at the expense of stability.
A frozen shoulder (also sometimes called adhesive capsulitis) is a thickening and tightening of the soft tissues that surround the shoulder joint. When these tissues become irritated and inflamed, they can become scarred. The scar tissue takes up space inside the joint that is normally used for motion. As a result, a person with a frozen shoulder has pain and a loss of range of motion.
The joint can become inflamed because of:
- Biochemical or hormone imbalances
- Changes in the immune system
- Diabetes. People with diabetes have a three times greater chance of developing frozen shoulder than the general population
- Immobilization for long time
- Injury to the shoulder
- Previous surgery
Symptoms of a Frozen Shoulder
Signs of a frozen shoulder are pain and a loss of the ability to move the shoulder fully. The pain may come on slowly or suddenly. As the discomfort and loss of motion get worse, even daily tasks become difficult or impossible to do.
Diagnosing a Frozen Shoulder
After taking a medical history and asking questions about the symptoms, a doctor will do a physical examination. He or she will evaluate how much and what kinds of motion are affected by the condition. It is important that other conditions that cause similar symptoms be ruled out.
If the condition cannot be diagnosed on the basis of a physical examination, other tests may be needed, including:
- X-rays. These are not helpful if only the soft tissues are affected. However, if the scarring has been caused by arthritis, fractures or metal plates inserted during a prior surgery, it will show up on an X-ray.
- Magnetic resonance imaging (MRI) does show soft tissue. An MRI may be helpful if another shoulder problem is suspected, such as a torn rotator cuff.
- Arthrogram. This may be done along with an MRI. Sometimes this is done after a dye has been injected into the shoulder joint. This helps make the structures of the joint show up better, especially in the tight spaces where the scarring is.
Treating a Frozen Shoulder
Without any treatment, a frozen shoulder can cause problems for one to three years. Even after that time, some people will continue to have stiffness and discomfort. They may still be able to do daily tasks, however.
Depending on how much pain there is and how much the frozen shoulder interferes with daily life, different treatment approaches are used.
A significant amount of improvement can take place with physical therapy and the use of nonsteroidal anti-inflammatory drugs. The goal of physical therapy is to strengthen the tendons around the joint and to stretch the joint so that motion is regained. If there isn't significant improvement within about six months, the joint should be reevaluated.
In older people who have a large amount of scarring - or in younger people who have been injured, surgery may be the best treatment. In the case of an injury, prompt surgery (within four weeks of the injury) may lead to a better recovery.
Surgery to Treat a Frozen Shoulder
Surgical treatment is done using minimally invasive techniques whenever possible.
Arthroscopic surgery can be used to remove scar tissue or bone spurs that interfere with the movement of the joint. In this type of surgery, a tiny fiber optic instrument is inserted into the joint. It can be used to assess the condition of the joint. It can also be used to remove scar tissue or bone spurs. If a torn rotator cuff is found, it can also be repaired at the same time.
Following surgery, patients usually need to stay in the hospital for one to two days. Physical therapy may started while the patient is still in the hospital. As soon as possible after surgery, patients are encouraged to use their shoulder joint. After leaving the hospital, the patient will be given a home stretching program to be done between formal physical therapy appointments.
About 10 days after surgery, the patient will return to the doctor to have the stitches removed. Until that time, the point where the incision was made should be kept clean, dry and covered.
In about three months after the patient has a full range of motion without pain he or she may start a program to strengthen the muscles that support the shoulder joint.