What is Frozen Shoulder Syndrome?

28 Sep What is Frozen Shoulder Syndrome?

Affecting 2% of the general population in the United States, frozen shoulder syndrome causes stiffness and pain of the shoulder. Also called adhesive capsulitis, this condition makes the shoulder hard to move. Frozen shoulder syndrome occurs most often between ages 40-60 years, and affects women more than men.

What causes frozen shoulder?

The shoulder is a ball-and-socket joint made of the clavicle (collarbone), scapula (shoulder blade), and humerus (upper arm bone). The head of the humerus fits into a socket in the shoulder blade. A capsule made of strong connective tissue surrounds the shoulder. To move easily, the joint capsule contains lubricating synovial fluid. With frozen shoulder, the capsule thickens and tightens due to adhesions (stiff bands of tissue).

Does frozen shoulder come on suddenly or gradually?

There are three stages of frozen shoulder syndrome. These are:

• Freezing – Last 6 weeks to 9 months, and involves gradual increase in pain and loss of motion.
• Frozen – Lasts 4-6 months, an involves improvement of pain but continued stiffness.
• Thawing – Takes 6 months to 2 years, and involves slow improvement of shoulder motion and little pain.

How is frozen shoulder syndrome diagnosed?

If you experience symptoms, you may be referred to an orthopedic surgeon. The doctor will first discuss your symptoms, take a medical history, and examine your shoulder. The doctor tests strength, flexibility, and range of motion. Imaging tests are used to rule out certain shoulder conditions and to evaluate the pain and stiffness. These include x-rays, magnetic resonance imaging (MRI) scans, and ultrasound.

How is frozen shoulder treated?

The goal of frozen shoulder syndrome treatment is to control pain and to restore strength and motion. The doctor uses several nonsurgical measures, including:

• Physical therapy – You work with a therapist who teaches you shoulder exercises that improve range of motion and prevent further joint damage. In addition, the therapist will use measure to relieve pain, such as heat therapy, cold therapy, ultrasound, and electrical stimulation.

• Medications – The doctor may prescribe anti-inflammatory agents to reduce swelling and pain.

• Corticosteroid injections – The orthopedic specialist can inject the shoulder joint with a steroidal agent. This is done in the office setting using real-time x-ray to guide the needle into proper position.

Will I require surgery?

If your symptoms do not improve with physical therapy, medications, and steroid injections, the orthopedic surgeon may recommend surgery. After discussing the risks and benefits of surgery for frozen shoulder syndrome, you and the surgeon will make the decision. The surgery is done using general anesthesia, so you will have no memory or pain. Frozen shoulder surgery is quite extensive. Depending on the severity of the condition, frozen shoulder surgery involves:

• Re-establishment of the humeroscapular motion interface – Removal of adhesions between the muscles and bone. The rotator cuff may need to be freed using dissection techniques.
• Opening the rotator interval – Involves release of the rotator structures by dissecting certain tendons to free them from the base of the coracoid structure.
• Re-establishment of subscapularis length and excursion – This involves removal of scar tissue and lengthening of the coronal plane and subscapularis tendon.
• Release of the capsule – The tight capsular tissue is released using cutting techniques.

What can I expect after frozen shoulder surgery?

Immediately after surgery, you will be monitored by a nurse for a couple of hours. Once awake, you may experience some soreness of the shoulder region. The arm is placed in a continuous passive motion device as soon as the procedure is complete. This prevents scarring and is critical for healing. The early movement is necessary for shoulder range of motion and to prevent stiffness. The surgeon will give you a nerve block right before recover, so pain is minimal.

Once you are moved to a room, a physical therapist meets with you to discuss your therapy program. Before discharge, you will be comfortable moving the arm in various positions. After going home, you are encouraged to move about your home, but should avoid heavy lifting or strenuous shoulder activities. You will return to the surgeon’s office in 3-7 days to have dressings, drains, and/or sutures removed. Total recovery time varies, but some patients have full use of the shoulder within 2-4 weeks.

Does frozen shoulder surgery work?

According to a recent study, patients who had frozen shoulder surgery had an increase in range of motion scores postoperative (from 9 to 31.6). The constant score went from 20 to 70, and the passive joint mobility values greatly improved. Overall, joint mobility values increased significantly after one week and remained stable at the 6-month follow-up.

Resources

Cohen M, Amatal MV, Brandao BL (2013). Assessment of the results from arthroscopic surgical treatment of adhesive capsulitis. Revista Bras Orthop, 48(3), 272-277.

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