Could You have Frozen Shoulder? Relieving Pain, Stiffness from This Fairly Common Condition

If you have a somewhat stiff and painful shoulder with a limited range of motion, then it could be a condition commonly known as “frozen shoulder.” Its medical term is adhesive capsulitis.

The causes of frozen shoulder are not fully understood. There is not even a “clear connection to arm dominance or occupation,” according to the America Academy of Orthopedic Surgeons (AAOS). Frozen shoulder most commonly affects people between the ages of 40 and 60, and occurs in women more often than men. It is estimated that 5 percent to 20 percent of adults will suffer from frozen shoulder at some point.

Anthony Miniaci, M.D., an orthopedic surgeon and deputy chief medical executive of Baptist Health Orthopedic Care.

 

Frozen shoulder occurs more often in people with diabetes. Some additional medical problems associated with frozen shoulder include hypothyroidism, hyperthyroidism, Parkinson's disease, and heart disease. Frozen shoulder can also develop after a shoulder has been immobilized for a period of time due to surgery, a fracture, or other injury.

“If frozen shoulder is diagnosed in someone with diabetes, it is often associated with uncontrolled blood sugar levels,” explains Anthony Miniaci, M.D., an orthopedic surgeon and deputy chief medical executive of Baptist Health Orthopedic Care.

Dr. Miniaci recalls diagnosing diabetes in a patient who consulted with him about a stiff and painful shoulder. “The patient’s frozen shoulder diagnosis led to a check of blood sugar levels, which helped diagnose diabetes,” he said.

Painful symptoms and a limited range of motion can persist for several months before the “thawing” stage of a frozen shoulder begins. A complete return to normal, or close to normal strength and motion, typically takes from 6 months to 2 years.

What Exactly is “Frozen Shoulder”

The head of shoulder bone fits into a shallow socket in your shoulder blade. Strong connective tissue, called the shoulder capsule, surrounds the joint. To help your shoulder move more easily, synovial fluid lubricates the shoulder capsule and the joint. When frozen shoulder set in, the shoulder capsule thickens and becomes stiff and tight. Thick bands of tissue — called adhesions — develop. In many cases, there is less synovial fluid in the joint.

Anti-inflammatory drugs, such as ibuprofen, pain-relief creams or lotions, and heat/ice applications may help temporarily relief symptoms -- as can some exercises or massage therapies. “Such at-home treatments won’t make a frozen shoulder get better faster, but they may help with some symptoms to some extent,” Dr. Miniaci cautions.

Diagnosis and Treatments

When diagnosing for frozen shoulder, your doctor will move your shoulder carefully in all directions to see if movement is limited, and if pain occurs with the motion. X-rays, magnetic resonance imaging (MRI) and ultrasounds are not required to diagnose frozen shoulder – but they may help to identify other shoulder problems, such as a torn rotator cuff.

Depending on severity and other underlying health issues, there are a range of treatment options for frozen shoulder, including physical therapy, cortisone Injections and hydrodilatation, and surgery.

“We can provide a cortisone shot to reduce inflammation and stiffness, but that might help for a few weeks or months and the effectiveness varies by patient,” said Dr. Miniaci. “However, patients with diabetes should speak to their doctor about whether a cortisone injection is a good option since these shots can raise blood sugars.”

If your symptoms are not relieved by nonsurgical methods, Dr. Miniaci may recommend hydrodilatation. “This involves gently injecting a large volume of sterile fluid into the shoulder joint to expand and stretch the shoulder joint capsule,” he explains. “I usually follow hydrodilatation with a cortisone injection.”

Surgical Treatments

If frozen shoulder symptoms are not relieved by physical therapy and other conservative treatments, surgery may be an option – although it is usually the option of last resort. The goal of surgery is to stretch and release the stiffened joint capsule. The most common methods include manipulation under anesthesia and shoulder arthroscopy.

With manipulation under anesthesia, the shoulder is moved which causes the capsule and scar tissue to stretch or tear. This releases the tightening and increases range of motion. With shoulder arthroscopy, the surgeon will cut through tight portions of the joint capsule. This is done using pencil-sized instruments inserted through small incisions around the shoulder. In many cases, manipulation and arthroscopy are used in combination to obtain maximum results. Most patients have good outcomes with these procedures.