What Is Frozen Shoulder? What Causes Frozen Shoulder? What Is Adhesive Capsulitis?
Editor's ChoiceMain Category: Bones / Orthopedics
Also Included In: Rehabilitation / Physical Therapy; Sports Medicine / Fitness; Pain / Anesthetics
Article Date: 04 Oct 2009 - 11:00 PDT
What Is Frozen Shoulder? What Causes Frozen Shoulder? What Is Adhesive Capsulitis?
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Frozen shoulder, also known as adhesive capsulitis, is a common condition in which the articular shoulder capsule (a sac of ligaments surrounding the joint) swells and stiffens, restricting its mobility. It typically affects only one shoulder, but one in five cases affect both.
The term "frozen shoulder" is often used incorrectly for arthritis, even though the two conditions are unrelated. Frozen shoulder refers specifically to the shoulder joint, while arthritis may refer to other/multiple joints.
The shoulder has a spheroidal joint (ball - and - socket joint), in which the round part of one bone fits into the concavity of another. The proximal humerus (round head of the upper arm bone) fits into socket of the scapula (shoulder blade). Frozen shoulder is thought to cause the formation of scar tissue in the shoulder, which makes the shoulder joint's capsule (not to be confused with the rotator cuff) thicken and tighten, leaving less room for movement. Therefore, movement may be stiff and even painful.
The modern English words "adhesive capsulitis" are derived from the Latin words adhaerens meaning "sticking to" and capsula meaning "little container" and the Greek word itis meaning "inflammation".
According to MediLexicon's medical dictionary, adhesive capsulitis is: "A condition in which joint motion becomes restricted because of inflammatory thickening of the capsule; a common cause of shoulder stiffness."
Frozen shoulder is a condition that targets people between 40 and 60 years of age - women more often than men.
What causes frozen shoulder?
The cause of frozen shoulder is not fully understood and in some cases is unidentifiable. However, most people with frozen shoulder have suffered from immobility as a result of a recent injury or fracture. It is common in people with diabetes.What are the risk factors for frozen shoulder?
A risk factor is something that elevates the risk of developing a disease or condition. For example, smoking is a risk factor for cancer - it elevates the risk of developing lung cancer. Common risk factors for frozen shoulder are:- Age - being over 40 years of age.
- Gender - 70% of people with frozen shoulder are women.
- Recent surgery or arm fracture - immobility of recovery may cause the shoulder capsule to stiffen.
- Diabetes - two to four times more likely to develop frozen shoulder for unknown reasons; symptoms may be more severe.
- Having suffered a stroke.
- Hyperthyroidism (overactive thyroid).
- Hypothyroidism (underactive thyroid).
- Cardiovascular disease (heart disease).
- Parkinson's disease.
What are the signs and symptoms of frozen shoulder?
A symptom is something the patient feels and/or reports, while a sign is something others, including the doctor observe. For example, pain is usually a symptom, while a rash could be a sign.There are three stages of frozen shoulder:
- Painful stage - the shoulder becomes stiff and then very painful with movement. Movement becomes limited. Pain typically worsens at night.
- Frozen/adhesive stage - the shoulder becomes increasingly stiff, severely limiting range of motion. Pain may not diminish, but it does not usually worsen.
- Thawing stage - movement in the shoulder begins to improve. Pain may fade, but occasionally recur.
How is frozen shoulder diagnosed?
Doctors will most likely diagnose frozen shoulder based on signs and symptoms and a physical exam; paying close attention to the arms and shoulders. The severity of frozen shoulder is determined by a basic test in which a doctor presses and moves certain parts of the arm and shoulder.Structural problems can only be identified with the help of imaging tests, such as an X - ray or MRI. An X-ray is a type of electromagnetic radiation that can penetrate most solid objects to create images of an object's interior. An MRI (magnetic resonance imaging) uses magnetic signals to create image "slices" of the soft tissues inside the human body.
What are the treatment options for frozen shoulder?
The aim of treatment for frozen shoulder is to alleviate pain and preserve mobility and flexibility in the shoulder. However, recovery may be slow, as symptoms tend to persist for several years.Treatment options for frozen shoulder include:
- Painkillers - relieve symptoms of pain. Nonsteroidal anti - inflammatory drugs (NSAIDs), such as ibuprofen, are over - the - counter (OTC, no prescription required) painkillers and may reduce inflammation of the shoulder in addition to alleviating mild pain. Acetaminophen (paracetamol, Tylenol) is recommended for extended use. Prescription painkillers, such as codeine (an opiate - based painkiller) may also reduce pain. Not all painkillers are suitable for every patient; be sure to review options with your doctor.
- Exercise - frequent, gentle exercise can prevent and even reverse stiffness in the shoulder.
- Hot or cold compression packs - help to reduce pain and swelling. It is often helpful to alternate between the two.
- Corticosteroid injections - a type of steroid hormone that reduces pain and swelling. Corticosteroids may be injected into the shoulder joint to alleviate pain, especially in the 'painful stage' of symptoms. However, repeated corticosteroid injections are discouraged as they could cause damage to the shoulder.
- Transcutaneous electrical nerve stimulation (TENS) - numbs the nerve endings in the spinal cord that control pain and sends small pulses of electricity from the TENS machine to electrodes (small electric pads) that are applied to the skin on the affected shoulder.
- Physical therapy (UK: physiotherapy) - can teach you exercises to maintain as much mobility and flexibility as possible without straining the shoulder or causing too much pain.
- Shoulder manipulation - the shoulder joint is gently moved while you are under a general anesthetic (a drug that makes you completely unconscious).
- Shoulder arthroscopy - a minimally invasive type of surgery used in a small percentage of cases. A small endoscope (tube) is inserted through a small incision into the shoulder joint to remove any scar tissue or adhesions.
If you experience stiffness in the shoulder joint it is recommended that you seek medical attention sooner rather than later in order to prevent permanent stiffness.
How can frozen shoulder be prevented?
Frozen shoulder can only be prevented if it is caused by an injury that makes shoulder movement difficult, in which case the patient should talk to a doctor about what exercises can maintain mobility and flexibility of the shoulder joint.Written by Caroline Gillott
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Visitor Opinions (latest shown first)
Frozen Shoulder
posted by Mary C on 14 May 2013 at 11:09 amMy frozen shoulder started June 2012. My two sisters had it prior to me--several years earlier. One sister had the manipulation and the corisones injections; of which the frozen shoulder came back. The other sister had it in both shoulders; advised me she went thru the freeze, frozen, thaw cycle-and let it heal on its own. I went to the ortho specialist; had x-rays; he suggested it was frozen shoulder; offering injections or PT. I opted to 'go it on my own'; knowing it would take 4 mos of freeze, 4 mos of frozen and 4 mos of 'thaw' cycle. I am in the latter part of the 'thaw' cycle and the frozen shoulder is almost completely gone; I have almost full range of motion.
Sometime you just need to allow you body to heal on its own--in it's own timing. We live in such a 'have to have it now' world--but allowing it to heal on its own--without breaking the body's own natural healing time--I don't believe it will come back. It was very painful going thru it; but nothing that I couldn't stand. Knowing ahead of time it would take a year to heal--made all the difference. It is of my opinion that possibly stress combined with excessive use of the arm/shoulder cause this condition. From what I've read; once you've had it; and have allowed it to heal the full term; it should not come back.
My experience
posted by R T Perkins on 11 Apr 2013 at 8:22 pmWoke up one morning (3 mos. ago) with much pain in left shoulder for no reason. Thought it was a pinched nerve from the way I slept that night. My arm would just hang at my side and I could not find a position, even when lying down at night to sleep, where it would have no pain. Went to Vet Admin Doctor after the first mo. and was told to put Tiger Balm on it and it would be fine in 60 days (NOT !!!). Almost 90 days later I went to a Chiropractor that specialized in "Bio-mechanical" Sports and Performance Manipulation.
Saw him yesterday. Amazing.. Fantastic.. Unbelievable.
I spent 11 hours today installing a laminate floor and I might have had 3 times I had a little pain.
How can a one hour session of shoulder manipulation allow me to have use of my arm back ??? What gives ??
More studies should be done to find the cause. I don't agree entirely with what I have read.
posted by Carol on 3 Apr 2013 at 8:20 amI am on my 3rd year recovering from Frozen Shoulder in my dominant left shoulder. Mine was coming on slowly until I accidentally tore my anterior labrum lifting, moving and hauling heavy lumber one day. My shoulder completely froze 3 days later. After many cortisone injections and 12 weeks of physical therapy that did NOT work, I had a manipulation done under general anesthesia. It was only AFTER the manipulation that physical therapy to get my rotation back actually worked.
12 more weeks of PT and then one more injection into the joint (different type of medication, the doctor said) I haven't needed to go back to the Orthopedist for a year now. My shoulder is still painful and I have to be careful with movements due to the tear in my cartilage but I now know I must stretch it several times per day. I have definitely lost strength in that arm. I am trying to get that back without further damaging it but it is painful.
Now it's starting in the other shoulder (ugh!) I stretch that shoulder several times per day too in hopes to ward off potentially getting FS in that one. I have a feeling FS is caused by first OVER use over long periods of time, followed by not using it so much due to increasing pain. Also, it seemed to start with tennis elbow in my left shoulder at first. I have developed that in my right elbow and my right shoulder pain is increasing ... just like my left did..... PLEASE, NOT AGAIN!!!!
MY Frozen Shoulder
posted by Willow D Gates on 6 Feb 2013 at 8:55 amMY Frozen Shoulder
My right shoulder started hurting 2 weeks before Christmas. I took a MRI first. The Doctor told me that it was not enough to do surgery. The Doctor sent me to therapy. I went for 4 weeks and that made it feel better. I hope that it dont come back.
Frozen Shoulder - Acupuncture Treatment
posted by Vaishali Gupte on 1 Feb 2011 at 9:05 pmI was suffering with Frozen shoulder. So I started doing exercises and then I went for Acupuncture (Chinese Needle Treatment) treatment and have just completed 5 sittings and feeling much better. But along with Acupuncture exercise is a must.
My experience
posted by Gloria Roces on 8 Nov 2010 at 4:52 pmMy left shoulder pain started before Xmas and progressively got worse in May 2010 while I was in San Francisco, my home town. There I had acupuncture which helped a bit, but acute pain persisted non-stop and brought tears to my eyes. In Vienna, Austria where I live, I started a program of therapy/treatment in late May 2010 2-3x a week, and continues until now, but only once a week.
The pain has subsided and does strike and comes and goes suddenly. I would say I feel much better ca 60-70%. During therapy I had consultations with 2 shoulder specialists, with the second opinion saying surgery not necessary for the time being. My physician, Dr. Peter Zillner, has succeeded in easing my pain and great discomfort, but not 100% yet.
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