Frozen Shoulder

Frozen shoulder or adhesive capsulitis is a painful shoulder problem that causes restricted shoulder mobility. This is a condition that occurs in middle age and seems to come on without any specific injury or incident. Patients often say that they feel that they "tweaked" or "twisted" their shoulder at some point and thereafter developed pain and stiffness in their shoulder. Common complaints are severe pain at night, shooting pain in the shoulder area and difficulty reaching behind the back or lifting the arm up. Women may notice difficulty reaching their bra behind their back.

We currently know that in frozen shoulder the cells living in the capsule ligaments surrounding the ball and socket joint become inflamed. As a result, they release various signaling molecules that cause the collagen structure of the shoulder capsule to thicken and constrict. This causes painful limited motion from the shoulder. Frozen shoulder goes through three stages. First, the "freezing" stage occurs as the shoulder is very painful and becomes stiffer. Second, the "frozen" stage occurs when much of the severe pain remits, but the shoulder remains very stiff. Finally, the "thawing" stage occurs as the stiffness resolves. This condition affects 2% of people at some point and is slightly more common in women than men. It occurs more commonly in people with diabetes, low thyroid, and cardiac disease, though it is not necessarily caused by these medical problems.

The good news is that 90-95% of cases of frozen shoulder resolve without surgery. However, it can take up to 24 months without treatment. Initial treatment is focused on reducing the inflammatory process in the capsule ligaments of the shoulder. This may be done with a course of anti-inflammatory pills (Motrin or Alleve). The most powerful method of reducing the inflammation from frozen shoulder is a cortisone injection given into the shoulder capsule. This may be combined with gentle stretching exercises.

If symptoms do not resolve with these measures, surgical treatment may be considered. This is done by placing an arthroscopic camera and a probe into the shoulder through small incisions in the shoulder. The probe is then used to release the contracted capsule and remove the inflammatory components fully from the shoulder. The above picture demonstrates on the left the red inflammation from frozen shoulder. The picture to the right shows the same shoulder after the capsule has been released arthroscopically and inflammation has been removed. Physical therapy can start within one or two days of surgery.

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