“I just woke up with shoulder pain.” “I can barely put a coat on or brush my hair.” “Reaching for something on a top shelf seems impossible.” “My arm just feels sore and stiff.” Sound familiar? All of these symptoms are typical complaints of someone with a frozen shoulder (or adhesive capsulitis). It ‘s a common problem that starts with a lot of pain all of a sudden, followed by a gradual loss of motion.
What causes this pain and loss of motion? Your shoulder joint is surrounded by a connective tissue called the capsule. When the capsule gets inflamed it causes pain and scarring. Once the capsule is thickened or scarred, you shoulder motion will be limited – both when you try to move it (active range of motion) and when someone else tried to move it (passive range of motion). The loss of both active and passive range of motion is the hallmark of frozen shoulder.
With all that being said, how do you actually get a frozen shoulder? A lot of times it is just being unlucky. The most common cause is no cause at all. Sometimes, it can be precipitated by an injury but most of the time it just happens. It is more common in women aged 40-60 and in diabetics (especially those that are insulin pump dependent). It is also found to be associated with thyroid disease, heart disease and lung disease.
Frozen shoulder can be broken down into 3 phases: painful, frozen and thawing. The Painful phase is just that – painful. An all the time, deep and gnawing pain is common. You will gradually start to lose motion during this period. The frozen phase is where your motion bottoms out and is most limited. Pain is usually slightly less and is worse when you try to move beyond your shoulder’s limits. The thawing phase is marked by a gradual return to near normal range of motion over a long period of time.
So how do we treat a frozen shoulder? Well, there is some good news and some bad news there. First the good news. If you leave a frozen shoulder alone and don’t do any active treatment, it will almost always get better on its own. Here’s the bad news…it can take 12 to 18 months or longer to go away. If you are like most of our patients, you are saying, “there has got to be something we can do to make it go away faster?” The literature is pretty clear and consistent and the bottom line is that nothing really makes any long term difference in the length of symptoms. Not injections, not medications, and not physical therapy. I realize that does not make much sense intuitively, but stretching exercises and manual release therapy have never been shown to make any difference in the treatment of frozen shoulder. There is one exception, if it is caught early enough in the painful phase sometimes an intra-articular cortisone injection can help resolve your symptoms before it progresses to the frozen phase, and then physical therapy might be helpful.
If you begin to get frustrated and don’t want to wait for your symptoms to resolve there is always a surgical option. This would entail a manipulation under anesthesia (MUA) and an arthroscopic capsular release. During this procedure we cut the adhesions in your shoulder and remove portions of the scarred capsule. After surgery we strongly enforce going to physical therapy every day for 2 weeks in order to maintain the range of motion obtained at the time of surgery. You are usually in physical therapy about 2-3 times per week for several weeks after that in order to help maintain your range of motion. The results of this surgery are very good but because this problem usually gets better on its own, surgery only changes the time frame.
If you feel like might be developing a frozen shoulder, give us a call to make an appointment and help you weigh out your options.