Health Encyclopedia

Frozen shoulder

Definition

Frozen shoulder is the common term for adhesive capsulitis, an inflammatory condition that restricts motion in the shoulder.

Alternative Names

Adhesive capsulitis

Causes, incidence, and risk factors

The capsule of a shoulder joint includes the ligaments that attach the shoulder bones to each other. When inflammation occurs within the capsule, the shoulder bones are unable to freely move within the joint.

Diabetes, shoulder trauma (including surgery), a history of open heart surgery, hyperthyroidism, and a history of cervical disk disease are all associated with an increased risk for this problem. Often, there is no known cause.

Symptoms

The main symptoms are pain and stiffness.

In those with idiopathic frozen shoulder (frozen shoulder without an identifiable cause), pain is usually the first symptom. The patient usually does not want to move the arm. The lack of movement leads to stiffness, which is the second phase of the disease. The third phase, thawing, is when the motion and function of the shoulder slowly returns.

Signs and tests

The diagnosis is made primarily by physical exam and the patient's medical history. There is usually a history of shoulder pain followed by severe stiffness, which may not be very painful. If the patient has any history of the risk factors associated with frozen shoulder, these may require treatment as well.

Imaging studies such as x-rays are routine to make sure there is no other problem, such as arthritis. MRI exams may show widespread inflammation, but there are no findings specific to frozen shoulder.

Treatment

Treatment involves non-steroidal anti-inflammatory medications (NSAIDs), steroid injections, and physical therapy. It can take as long as 12-18 months to see improvement. The physical therapy is intense and needs to be done every day. Steroid injections can significantly improve the results of physical therapy.

If therapy is not successful, or if a patient can not tolerate therapy, a shoulder manipulation may be performed. This procedure is done under anesthesia. The health care provider will forcibly bring the shoulder through a range of motion to release the scar tissue.

Arthroscopic surgery can be used to cut the tight ligaments and remove the scar tissue from the shoulder. Some surgeons may use repeated pain blocks after surgery so the patient can participate in physical therapy after surgery.

Expectations (prognosis)

With therapy and NSAIDs, the problem will usually resolve within a year. When required, surgery is usually successful in restoring motion, but therapy must be continued for several weeks to months after surgery to prevent recurrence. The most common reason for any treatment to fail is non-compliance with therapy.

Complications

Complications include persistent stiffness and pain despite therapy. If there is forceful manipulation of the shoulder during surgery, the arm can break.

Calling your health care provider

If you have shoulder pain and stiffness and suspect you may have a frozen shoulder, contact your health care provider for proper referral and treatment.

Prevention

The best way to prevent frozen shoulder is to contact your health care provider if you develop shoulder pain that limits your range of motion for an extended period of time. This will allow early treatment and help avoid stiffness, if possible.

Patients with diabetes should keep tight control of their blood glucose levels.

References

Sheridan MA, Hannafin JA. Upper extremity: emphasis on frozen shoulder. Orthop Clin North Am. 2006 Oct;37(4):531-9. Review.

Brue S, Valentin A, Forssblad M, Werner S, Mikkelsen C, Cerulli G. Idiopathic adhesive capsulitis of the shoulder: a review. Knee Surg Sports Traumatol Arthrosc. 2007 Feb 28; [Epub ahead of print].

Review Date:3/9/2007
Reviewed By:Thomas N. Joseph, MD, Private Practice specializing in Orthopaedics, CamdenBone & Joint, Camden, SC. Review provided by VeriMed Healthcare Network.

ADAM Quality A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is the first of its kind, requiring compliance with 53 standards of quality and accountability, verified by independent audit. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial process. A.D.A.M. is also a founding member of Hi-Ethics (www.hiethics.com) and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The Agency for Health Care Administration (Agency) and this website do not claim the information on, or referred to by, this site is error free. This site may include links to websites of other government agencies or private groups. Our Agency and this website do not control such sites and are not responsible for their content. Reference to or links to any other group, product, service, or information does not mean our Agency or this website approves of that group, product, service, or information.

Additionally, while health information provided through this website may be a valuable resource for the public, it is not designed to offer medical advice. Talk with your doctor about medical care questions you may have.