Frozen shoulder

 

Alternative Names

Adhesive capsulitis

Definition

Frozen shoulder is when the shoulder is painful and loses motion because of inflammation.

Causes

The capsule of the shoulder joint has ligaments that hold the shoulder bones to each other. When the capsule becomes inflamed, the shoulder bones are unable to move freely in the joint.

Most of the time there is no cause for frozen shoulder. Risk factors include:

Symptoms

The main symptoms are:

  • Decreased motion of the shoulder
  • Pain
  • Stiffness

Frozen shoulder without any known cause starts with pain. This pain prevents you from moving your arm. Lack of movement leads to stiffness and then even less motion. Over time, you become unable to do movements such as reaching over your head or behind you.

Exams and Tests

The health care provider will ask about your symptoms and an examine your shoulder. A diagnosis is often made when you are not able to rotate your shoulder.

You may have x-rays of the shoulder. This is to make sure there is no other problem, such as arthritis. Sometimes an MRI exam shows inflammation. But imaging tests do not show specific signs to diagnose frozen shoulder.

Treatment

Pain is treated with nonsteroidal anti-inflammatory medications (NSAIDs) and steroid injections. Steroid injections plus physical therapy can improve your motion.

It can take a few weeks to see progress. It may take as long as 6 - 9 months for complete recovery. Physical therapy is intense and needs to be done every day.

Left untreated, the condition often gets better by itself within 2 years with little loss of motion.

Risk factors for frozen shoulder, such as diabetes or thyroid problems, should also be treated.

Surgery is recommended if nonsurgical treatment is not effective. This procedure (shoulder arthroscopy) is done under anesthesia. During surgery the scar tissue is released by bringing the shoulder through a full range of motion. Arthroscopic surgery can also be used to cut the tight ligaments and remove the scar tissue from the shoulder. After surgery, you may receive pain blocks so you can participate in physical therapy.

Outlook (Prognosis)

Treatment with physical therapy and NSAIDs will usually restore motion and function of the shoulder within a year. Even untreated, the shoulder can get better by itself in 24 months.

After surgery restores motion, you must continue physical therapy for several weeks or months to prevent the frozen shoulder from returning. Treatment may fail if you cannot keep up with physical therapy.

Possible Complications

  • Stiffness and pain continue even with therapy
  • The arm can break if the shoulder is moved forcefully during surgery

When to Contact a Medical Professional

If you have shoulder pain and stiffness and think you have a frozen shoulder, contact your health care provider for 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. Early treatment and helps prevent stiffness.

People who have diabetes will be less likely to get frozen shoulder if they keep their condition under control.

References

Miller RH, Dlabach JA. Shoulder and elbow injuries. In: Canale ST, Beatty JH, eds. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, PA: Elsevier Mosby; 2007:chap 44.

Krabak BJ, Banks NL. Adhesive capsulitis. In: Frontera WR, Silver JK, eds. Essentials of Physical Medicine and Rehabilitation. 2nd ed. Philadelphia, PA: Elsevier Saunders; 2008:chap 10.

Review Date: 11/15/2012
Reviewed By: C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, Stephanie Slon, and Nissi Wang.

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