Frozen Shoulder

The defining characteristic of a stiff shoulder is limitation of both active and passive motion of the glenohumeral (shoulder) joint.  While, the term frozen shoulder is most often used to describe a stiff shoulder without a known cause, many known factors can contribute to a higher risk of developing a secondary frozen shoulder:

  • Diabetes
  • Thyroid Disorder
  • Trauma/Fracture
  • Immobilization
  • Parkinson’s
  • Cardiac Disease
  • Shoulder Surgery
  • Arthritis
  • Cervical Radiculopathy
  • Peripheral Neuropathy
  • Hypoadrenalism
  • Stroke
  • Calcific Tendinosis
  • Rotator Cuff Tear/Tendinosis
  • AC Arthritis
  • Pulmonary Disease
  • Corticotropin deficiency
  • Fibromatosis
  • Breast Surgery
  • Myofascial Pain Syndrome
  • Hyperlipidemia

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At any one time 2-3% of the population is suffering with a frozen shoulder. Both men and women are at risk with the most common being those between 40-70 years of age.

Pain due to frozen shoulder can vary from dull and aching to very sharp and sudden especially with attempted motion.

The course of frozen shoulder has often been described as having 3 stages:

  • Stage one: In the “freezing” stage, which may last from six weeks to nine months, the patient slow onset of pain. As the pain worsens, the shoulder loses motion.
  • Stage two: The “frozen” stage is marked by a slow improvement in pain, but the stiffness remains. This generally lasts four months to nine months.
  • Stage three: The final stage is the “thawing”, during which shoulder motion slowly returns toward normal. This generally lasts five months to 26 months.

Treatment Options

Frozen shoulder will generally get better on its own. However, this takes some time, occasionally as long as three years. If you have a stiff and painful shoulder, see your physician to make sure no other injuries are present.

Initial treatment is aimed at reducing the inflammation and pain followed by gradual restoration of motion and function. Heat is often reported by patients to provide relief. Anti-inflammatory medications may also provide relief. In our experience, an intra-articular corticosteroid injection can also be helpful.

Along with supervised therapy, patients should perform gentle passive stretching four to five times daily, preferably in the supine position. It is important to perform frequent but short sessions because the shoulder will become stiff again between each session.

Prior to initiating surgical intervention, an extended course of rehabilitation is recommended. When considering surgical intervention, the causes and goals of treatment must be clearly defined. Many options for treatment including manipulation under anesthesia and open release have been reported.

Our preferred method of surgical treatment is arthroscopic capsular release.

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Arthroscopy allows thorough evaluation of the shoulder to ensure all contributing factors for pain and stiffness are adequately addressed. As the capsule is most often the structure responsible for the stiffness, arthroscopy allows us to precisely release only this tissue, minimizing the risk of injury to healthy tissue.

Our protocol includes performing the procedure with a regional block and pain pump allowing patients to initiate pain free motion and rehabilitation after surgery. As many patients have suffered with persistent shoulder pain for an extended period of time, this allows patients to rehabilitate with more confidence.

Most patients have very good results with these procedures. After surgery, physical therapy is important to maintain the motion that was achieved with surgery. Most patients require six weeks to three months of recovery.