What is a frozen shoulder?
Adhesive capsulitis, or frozen shoulder, is a painful condition that occurs in the shoulder. This condition is separated from other painful conditions of the shoulder that result in tightness due to the fact that there is a loss of motion in all planes. The good news is that you should not need surgery. The bad news is that you will be uncomfortable for some time.
Frozen shoulder typically occurs in patients between the ages of 40 and 70. We used to think that it occurred more commonly in women than men but this has turned out to not necessarily be the case. There are some conditions that it is commonly associated with such as diabetes mellitus and patients with thyroid conditions. It can also occur after an injury or surgery. Typically, it will not recur in the same shoulder. Rarely, some patients develop frozen shoulder at some time in the future in the opposite shoulder.
Frozen shoulder is a biologic problem. What I mean by this is that it changes the nature of the capsule, or shrink-wrap around the shoulder joint. Typically, the shoulder capsule is thin and somewhat elastic allowing for a great range of motion. In the case of frozen shoulder, the capsule becomes many times thicker than normal. Think of the capsule as a rubber band. A thin rubber band – the normal shoulder capsule – is easier to stretch than a thicker rubber band – the capsule in a patient with frozen shoulder.
What to Expect
There are typically three stages to a frozen shoulder. Initially there is pain with all ranges of motion. Over the course of days to weeks the shoulder becomes tighter and tighter. Ultimately the pain improves but the shoulder remains stiff. This can last weeks or even months. No matter how much you try to stretch, it doesn’t seem to release. Finally the thawing phase starts. Gradually over the course of a year or two your motion should return to near normal.
The overwhelming majority of patients can rehabilitate on their own with a series of gentle stretches. I often find that over-stretching causes an increase in pain without a significant improvement in range of motion. Sometimes, we will try oral medications or corticosteroid shots to help alleviate some of the discomfort. In rare cases, more common in patients with diabetes mellitus, if after six months or so the motion is not improved you and your surgeon may consider a visit to the operating room. This is where you undergo manipulation under anesthesia which may be combined with an arthroscopic release of the thickened capsule. You will then undergo physical therapy to maintain the motion that is regained in the operating room. Fortunately, most people with frozen shoulder are able to regain nearly normal motion and function in time.