Frozen Shoulder Syndrome
What is Frozen Shoulder Syndrome?
Frozen shoulder, also called adhesive capsulitis, causes
pain and stiffness in the shoulder. Over time, the shoulder
becomes very hard to move.
Frozen shoulder occurs in about 2% of the general
population. It most commonly affects people between the ages
of 40 and 60, and occurs in women more often than men.
In frozen shoulder, the shoulder capsule thickens and
becomes tight. Stiff bands of tissue — called adhesions —
develop. In many cases, there is less synovial fluid in the
The hallmark sign of this condition is being unable to
move your shoulder - either on your own or with the help of
someone else. It develops in three stages:
- Freezing - In the "freezing" stage, you
slowly have more and more pain. As the pain worsens,
your shoulder loses range of motion. Freezing typically
lasts from 6 weeks to 9 months.
- Frozen - Painful symptoms may actually
improve during this stage, but the stiffness remains.
During the 4 to 6 months of the "frozen" stage, daily
activities may be very difficult.
- Thawing - Shoulder motion slowly improves
during the "thawing" stage. Complete return to normal or
close to normal strength and motion typically takes from
6 months to 2 years.
What causes frozen shoulder?
Most often, frozen shoulder occurs with no associated
injury or discernible cause. There are patients who develop
a frozen shoulder after a traumatic injury to the shoulder,
but this is not the usual cause. Some risk factors for
developing a frozen shoulder include:
- Age & Gender
Frozen shoulder most commonly affects patients
between the ages of 40 to 60 years old, and it is twice
as common in women than in men.
- Endocrine Disorders
Patients with diabetes are at particular risk for
developing a frozen shoulder. Other endocrine
abnormalities, such as thyroid problems, can also lead
to this condition.
- Shoulder Trauma or Surgery
Patients who sustain a shoulder injury, or undergo
surgery on the shoulder can develop a frozen shoulder
joint. When injury or surgery is followed by prolonged
joint immobilization, the risk of developing a frozen
shoulder is highest.
- Other Systemic Conditions
Several systemic conditions such as heart disease
and Parkinson's disease have also been associated with
an increased risk for developing a frozen shoulder.
What are the symptoms of frozen shoulder?
- Shoulder pain; usually a dull, aching pain
- Limited movement of the shoulder
- Difficulty with activities such as brushing hair,
putting on shirts/bras
- Pain when trying to sleep on the affected shoulder
How is frozen shoulder diagnosed?
- Physical Examination - After discussing your
symptoms and medical history, your doctor will examine
your shoulder. Your doctor will move your shoulder
carefully in all directions to see if movement is
limited and if pain occurs with the motion. The range of
motion when someone else moves your shoulder is called
"passive range of motion." Your doctor will compare this
to the range of motion you display when you move your
shoulder on your own ("active range of motion"). People
with frozen shoulder have limited range of motion both
actively and passively.
- Imaging Tests - Other tests that may help
your doctor rule out other causes of stiffness and pain
- X-rays - Dense structures, such as bone,
show up clearly on x-rays. X-rays may show other
problems in your shoulder, such as arthritis.
- Magnetic resonance imaging (MRI) and
ultrasound - These studies can create better
images of problems with soft tissues, such as a torn
Frozen Shoulder Surgery
The surgeon may perform a manipulation under anesthesia.
A manipulation is performed with the patient sedated under
anesthesia, and the doctor moves the arm to break up
adhesions caused by frozen shoulder. There is no actual
surgery involved, meaning incisions are not made when a
manipulation is performed.
Alternatively, or in conjunction with a manipulation, an
arthroscope can be inserted into the joint to cut through
adhesions. This procedure is called an arthroscopic capsular
release. Surgical capsular release of a frozen shoulder is
rarely necessary, but it is extremely useful in cases of
frozen shoulder that do not respond to therapy and rehab. If
surgery is performed, immediate physical therapy following
the capsular release is of utmost importance. If rehab does
not begin soon after capsular release, the chance of the
frozen shoulder returning is quite high.