Your shoulder is a ball-and-socket joint made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle). The head of the upper arm 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.
The shoulder capsule surrounds the shoulder joint and rotator cuff tendons. In frozen shoulder, the smooth tissues of the shoulder capsule become thick, stiff, and inflamed.
Frozen shoulder (also called "Adhesive Capsulitis"), occurs when the shoulder capsule thickens and becomes tight. Stiff bands of tissue (called adhesions) develop in the shoulder. In many cases, there is less lubrication fluid (synovial fluid) in the joint. The main symptom of frozen shoulder is having limitation of movement of your shoulder in all directions.
Frozen shoulder causes pain and progressive stiffness in the shoulder. Frozen shoulder occurs in about 2% of the general population. It most commonly affects people between the ages of 40 and 60 and is more common in women.
Frozen shoulder is named due to the way the conditions develops. Frozen shoulder goes through the following stages:
Pain from frozen shoulder is usually dull or aching and can be very severe. It is typically worse early during the disease and when you move your arm. The pain associated with frozen shoulder is usually located over the outer shoulder area and sometimes the upper arm. You may experience pain at night and may have difficulty sleeping on the affected side.
We don't fully understand the causes of a frozen shoulder. There is no clear connection to arm dominance or occupation. A few factors may put you more at risk or is associated for developing frozen shoulder:
After discussing your symptoms and medical history, Dr van den Berg will examine your shoulder. Your orthopaedic surgeon 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 a stiff shoulder and have limited range of motion both actively and passively.
Other tests that may help your doctor rule out other causes of stiffness and pain include:
Frozen Shoulder Management – http://www.youtube.com/watch?v=feEopNmKuzk
Frozen shoulder generally gets better over time, although it may take up to 3 years. The focus of treatment is to control pain and restore motion and strength through physical therapy.
More than 90% of patients with frozen shoulder improve with relatively simple treatments to control pain and restore motion.
If your symptoms are not relieved by non-operative measures for a period of at least 6 months, you and your doctor may discuss surgery. It is important to talk with your doctor about your potential for recovery continuing with simple treatments, and the risks involved with surgery for frozen shoulder. The goal of surgery for frozen shoulder is to stretch and release the stiffened joint capsule. The most common methods include manipulation under anesthesia and shoulder arthroscopy:
In many cases, manipulation and arthroscopy are used in combination to obtain maximum results. Most patients with frozen shoulder have very good outcomes with these procedures.
These photos are taken through an arthroscope to show a normal shoulder joint lining (left) and an inflamed joint lining damaged by frozen shoulder
Physiotherapy is necessary to maintain the motion that was achieved with surgery. Recovery times vary, from 6 weeks to three months. Although it is a slow process, your commitment to therapy is the most important factor in returning to all the activities you enjoy. Long-term outcomes after surgery are generally good, with most patients having reduced or no pain and greatly improved range of motion.
In some cases, however, even after several years, the motion does not return completely, and a small amount of stiffness remains. Although uncommon, frozen shoulder can recur, especially if a contributing factor like diabetes is still present.