Frozen Shoulder

What is Frozen Shoulder?

Frozen shoulder is a condition where the shoulder becomes stiff and painful to move. Surrounding the shoulder's ball-and-socket joint is a casing of tissue. With frozen shoulder (also called adhesive capsulitis), the lining of the shoulder joint becomes inflamed and can lead the capsule that surrounds the shoulder joint to contract. This makes the shoulder joint stiff and bands of scar tissue called adhesions form around the capsule, limiting mobility.

Normally, shoulder joints have the greatest range of motion of any joint in the body, but those with frozen shoulder will experience significant restriction on movement and pain associated with daily activities. Putting clothes on, brushing hair, shaving and other such actions will become increasingly difficult. With time, some pain may alleviate, but motion restriction will remain, even when others try to move the shoulder.

The pain from frozen shoulder is usually a dull, aching sensation throughout the outer shoulder area, even into the upper arm. This is worsened with movement and can disturb normal sleep. Midwest Orthopaedics at Rush (MOR) has among the most skilled and dedicated physicians who are specially trained in diagnosis and treatment of frozen shoulder. These award-winning Chicago shoulder specialists are at the forefront of research and innovation of advanced treatment practices.

Who is most likely to get frozen shoulder?

Frozen shoulder usually occurs in people age 40-60, with women being twice as likely to experience it as men. People with certain endocrine disorders (such as diabetes), cardiac disease or prolonged lack of use (such as after an injury) are at greater risk for developing this condition.

It is unknown why some people get this condition and others do not. People experiencing restricted shoulder mobility along with excessive pain should see an experienced orthopedic specialist. The physicians at Midwest Orthopaedics at Rush are among the nation's most experienced in shoulder diagnosis and treatment.

What are the symptoms of frozen shoulder?

Frozen shoulder typically develops slowly over a period of months and usually happens in three major stages. Each is identified as having a main attribute of pain, immobility then relief of pain with continued immobility.

  • Stage 1: This is the "freezing" stage in which any movement of the shoulder becomes painful. This is the most painful stage and can last from 6-12 months. As pain increases, mobility is affected.
  • Stage 2: This is the "frozen" stage and can last from 6-9 months. During this time, pain usually decreases while stiffness increases. The limited range of motion applies even when others try to move the arm.
  • Stage 3: This is the "thawing" phase where the shoulder gradually improves and motion returns. This may take 5-24 months

How is frozen shoulder diagnosed?

Physicians at Midwest Orthopaedics at Rush excel in shoulder treatments. They often diagnose frozen shoulder based on patient history and physical examination and might order the following tests to assist in their diagnosis:

  • X-ray: X-rays can help to ensure the shoulder joint appears normal, with no evidence of traumatic injury or arthritic changes.
  • MRI: This powerful diagnostic tool can sometimes show inflammation, but this test is better at ruling out other problems, rather than looking for frozen shoulder. If an MRI is conducted, an injection of contrast fluid into the shoulder joint prior to the MRI is necessary. Results indicating a scarred capsule would designate frozen shoulder.

What treatments are available for frozen shoulder?

Frozen shoulder treatment primarily consists of pain relief and physical therapy. Although the entire treatment process can take many months, more than 90 percent of frozen shoulder patients find relief with these simple treatments:

  • Anti-inflammatory medications: Taken primarily to ease pain, anti-inflammatory medicines such as ibuprofen can provide relief.
  • Cortisone injections: Used primarily to decrease the inflammation in the frozen shoulder joint, cortisone injections also help to decrease pain and in turn allow for more stretching and physical therapy.
  • Physical therapy: For motion restoration, physical therapy may be required under the direct supervision of a physical therapist or via a home program. Therapy increases the motion in the joint and minimizes the loss of muscle on the affected arm (muscle atrophy). Stretching and exercises are critical to successful frozen shoulder treatment. Exercises and stretches must be performed several times daily.
  • Moist heat: Moist heat helps loosen the joint and decrease pain. It is most effective when applied directly before stretching. Three times a day, apply a soaking hot washcloth to the shoulder joint for 10 minutes prior to stretching.
  • Nerve blocks: Nerve blocks are sometimes used to limit pain and allow more aggressive physical therapy.

If non-surgical treatments fail to improve shoulder motion and relieve pain from the frozen shoulder, surgery aimed at stretching or releasing the contracted joint capsule is occasionally necessary. In the past, a manipulation under anesthesia was often used for frozen shoulder. But today, physicians at Midwest Orthopaedics at Rush in Chicago are performing a capsular release by using a minimally invasive technique called arthroscopic surgery. The results are successful in more than 80% of patients and the freedom from pain is much quicker than with the closed manipulation.

Arthroscopic capsular release of a frozen shoulder is rarely necessary, but it is useful in cases of frozen shoulder that do not respond to therapy and rehabilitation.

What to expect with frozen shoulder treatment

Response to treatment depends on the procedure to alleviate frozen shoulder. Regardless of treatment, stretching, exercising and/or physical therapy are imperative to a successful outcome. If surgery is performed, immediate physical therapy is crucial. Otherwise, the chance of the frozen shoulder returning is high. Arthroscopic capsular release can restore normal range of motion within two months. Shoulder experts at Midwest Orthopaedics at Rush allow most of these patients to return to work and sports within four months of the procedure.

MOR's award-winning physicians are among the most skilled in diagnosis and treatment of shoulder conditions. They have a top team of professionals including nurses, anesthesiologists, physical therapists, surgeons and staff — all of whom are committed to treating patients with respect and excellence