Frozen Shoulder (Adhesive Capsulitis)

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Introduction

What is frozen shoulder?

Frozen shoulder is a painful condition with joint stiffness that can become very severe. Another name for the condition is adhesive capsulitis. It gets this name from the strong layer of connective tissue surrounding the shoulder joint. You may also hear it called frozen shoulder syndrome.

The shoulder is actually more than one joint. It contains three bones—the upper arm bone (humerus), shoulder blade (scapula), and collarbone (clavicle)—that form separate interacting joints with each other. A capsule of connective tissue covers the joint where the ball of the humerus fits into the socket of the scapula. It also contains groups of muscles and tendons, including the rotator cuff. Frozen shoulder results when this capsule thickens and tightens, restricting movement of the ball and socket joint. There may also be less lubricating joint fluid and stiff bands, or adhesions, may develop in the capsule. Eventually, scar tissue can form.

Frozen shoulder typically affects middle-aged adults between 40 and 60. It also tends to affect women more than men.

Frozen shoulder is rarely a medical emergency. However, it can be extremely painful. Seek prompt medical care if your shoulder is getting progressively more painful and stiff. This typically develops over several weeks. Your doctor will focus on relieving your pain and restoring movement to your shoulder. Seeing your doctor early can make it easier to reach these goals.

Symptoms

What are the symptoms of frozen shoulder?

Shoulder pain and stiffness are the hallmark symptoms of frozen shoulder. The pain is often dull and achy, but can be severe when you move the shoulder. It also tends to be worse when the condition is beginning. Shoulder stiffness can be so severe that you are unable to move the joint, even with assistance.

Frozen shoulder symptoms tend to start gradually in phases. The three frozen shoulder stages include:

  • Freezing: Shoulder pain and stiffness begins and slowly worsens over time. As the pain gets worse, shoulder stiffness increases. The pain may be worse at night. This stage can last up to nine months.

  • Frozen: Pain may actually improve in this stage, but the shoulder is very stiff. You may not be able to move your shoulder at all. This affects your ability to perform daily tasks, such as dressing and grooming. This stage can last up to six months.

  • Thawing: Shoulder stiffness begins to improve and joint motion slowly increases. It can take several months to a couple of years to regain normal strength and movement in the shoulder.

It’s important to seek medical care when you notice the onset of frozen shoulder symptoms. Your doctor may be able to diagnose the problem just from your symptoms and a physical exam. However, you may need imaging exams to rule out other causes and get an accurate diagnosis. If you begin treatment while you still have some range of motion, your doctor may be able to preserve it and prevent it from becoming totally frozen.

Causes

What causes frozen shoulder?

Health experts do not fully understand frozen shoulder causes and why it develops. The inflammation that leads to frozen shoulder tends to happen after an injury or when the shoulder has been immobile for a period of time. It may also happen when you have poor form when using the shoulder.

Risks

What are the risk factors for frozen shoulder?

Certain risk factors increase the likelihood of developing frozen shoulder. However, not all people with risk factors will end up with the condition. Your risk of frozen shoulder is higher if you have the following risk factors:

  • Age 40 years and older

  • Female gender

  • Recent shoulder injury or surgery

  • Stroke

  • Other medical conditions including diabetes, Parkinson’s disease, thyroid disease, and heart disease. Doctors do not have a clear understanding of the link between these conditions and frozen shoulder.

Reducing your risk of frozen shoulder

It is difficult to prevent frozen shoulder because doctors do not always know why it happens. If you have an injury or condition that immobilizes your shoulder, talk with your doctor about the risk of frozen shoulder. Ask if there are exercises you can do to try to prevent it. This may or may not be possible, depending on the injury or condition.

Treatments

How is frozen shoulder treated?

The goals of frozen shoulder treatment are relieving pain and restoring motion to the shoulder joint. In most cases, this is possible with nonsurgical treatments. In fact, 90% of cases improve with basic treatments including:

  • NSAIDs (nonsteroidal anti-inflammatory drugs), such as ibuprofen (Advil, Motrin) or naproxen (Aleve, Naprosyn) to reduce pain and swelling

  • Physical therapy, either with a physical therapist or through a home exercise program. Frozen shoulder exercises will stretch the muscles and increase movement and range of motion in the joint.

  • Steroid injections into the shoulder joint. These injections use powerful anti-inflammatory corticosteroids to help with pain and swelling.

Your doctor may recommend surgery if these treatments do not work. Frozen shoulder surgery includes manipulation under anesthesia and arthroscopy. For manipulation, you will receive general anesthesia and your doctor will force your shoulder to move. This releases the capsule by stretching it or sometimes tearing scar tissue. During arthroscopy, your doctor will cut scar tissue or tight areas of the capsule. Doctors often combine these procedures for the best results.

Complications

What are the potential complications of frozen shoulder?

Most people regain normal or almost normal strength and motion in their shoulder after treatment. However, it can take a great deal of time to fully recover—as long as three years. Without treatment, frozen shoulder usually resolves on its own, but it can take even longer.

Frozen shoulder does not usually recur in the same shoulder. However, it is possible to develop it in the other shoulder if risk factors are present.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2018 Feb 1
  1. Adhesive Capsulitis. American Academy of Family Physicians. https://familydoctor.org/condition/adhesive-capsulitis/
  2. Frozen Shoulder. American Academy of Orthopaedic Surgeons. https://orthoinfo.aaos.org/en/diseases--conditions/frozen-shoulder
  3. Frozen Shoulder. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/15359-frozen-shoulder
  4. Frozen Shoulder. Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/diseases-conditions/frozen-shoulder/symptoms-causes/syc-20372684
  5. Siegel LB, Cohen NJ, Gall EP. Adhesive capsulitis: a sticky issue. Am Fam Physician. 1999 Apr 1;59(7):1843-1850.
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