Frozen Shoulder

A frozen shoulder is a shoulder joint that has lost a substantial amount of its range of motion in all directions due to scarring around the joint. The range of motion is limited when the person tries to move the shoulder; moreover, it's painful when the doctor tries to move the joint fully, while the the person relaxes. A frozen shoulder is also referred to as adhesive capsulitis.

• A frozen shoulder may or may not be associated with pain in the shoulder.
• Initial pain and tenderness may resolve and leave the shoulder with painless but limited range of motion.
• The scarring of the shoulder joint capsule may limit the ability to move the shoulder fully in all directions.
• The limitation is usually most apparent when attempting to move the elbow completely away from the body.

A frozen shoulder is the result of inflammation, scarring, thickening, and shrinkage of the capsule that surrounds the normal shoulder joint. Any injury to the shoulder can lead to a frozen shoulder as a result of subsequent scar formation of the shoulder capsule. Injuries that can lead to a frozen shoulder include tendinitis, bursitis, and rotator cuff injury. Frozen shoulders occur more frequently in patients with diabetes, chronic inflammatory arthritis of the shoulder, or after chest or breast surgery. Long-term immobility of the shoulder joint can put people at risk to develop a frozen shoulder.

In evaluating a frozen shoulder, the doctor will consider the history of events that may have injured the shoulder joint. Any activity that could strain or injure the shoulder joint can lead to a frozen shoulder, including lifting a heavy object overhead, picking up luggage off of a luggage rack, or using shears to clip a hedge. A frozen shoulder is suggested during examination when the range of motion in the shoulder joint is significantly limited, with either the patient or the examiner attempting the movement.

Underlying diseases involving the shoulder can be diagnosed by the medical history along with the physical examination, blood testing, and X-ray examination of the shoulder. If necessary, the diagnosis can be confirmed when an X-ray contrast dye is injected into the shoulder joint to demonstrate the characteristic shrunken shoulder capsule of a frozen shoulder. This X-ray test is called arthrography. The tissues of the shoulder can also be evaluated with an MRI scan.

The treatment of a frozen shoulder usually requires an aggressive combination of anti-inflammatory medications, for example:

NSAIDs (nonsteroidal anti-inflammatory medicine for Frozen shoulder include

• aspirin, ibuprofen (Advil, Motrin)
• naproxen (Aleve), and
• cortisone injection(s) into the shoulder physical therapy.

Without aggressive treatment, a frozen shoulder can be permanent.

Diligent physical therapy to treat a frozen shoulder can include ultrasound, electric stimulation, range-of-motion exercises, ice packs, and strengthening exercises. Physical therapy can take weeks to months for recovery, depending on the severity of the scarring of the tissues around the shoulder. It is very important for people with a frozen shoulder to avoid reinjuring the shoulder tissues during the rehabilitation period. Avoid sudden, jerking motions or heavy lifting with the affected shoulder.

Anyone with limited motion of the shoulder joint should call their doctor.

Arthroscopic surgery and malipulating treatments for frozen shoulder. Frozen shoulders can be resistant to treatment. Other treatments such as release of the scar tissue by arthroscopic surgery or manipulation of the scarred shoulder under anesthesia may be considered for patients with resistant frozen shoulders. The manipulation is performed to physically break up the scar tissue of the joint capsule. This procedure carries the risk of breaking the arm bone (humerus fracture). It is very important for patients that undergo manipulation to partake in an active exercise program for the shoulder after the procedure. It is only with continued exercise of the shoulder that mobility and function is optimized. Once initial treatments have been initiated, the proper ongoing treatment is guided by the monitoring of your doctor.

Pain relief for a frozen shoulder usually requires an aggressive combination of anti-inflammatory medications, cortisone injection(s) into the shoulder, and physical therapy. Examples of medications that help relieve soreness, inflammation, and pain from frozen shoulder include NSAIDs (nonsteroidal anti-inflammatory drugs), for example, ibuprofen, naproxen (Naprosyn), diclofenac (Voltaren), and many others. Cortisone drugs can be used briefly, either orally (prednisone or prednisolone) or injected into the joint (Depo-Medrol, Kenalog, Celestone). Cold packs can be applied to the shoulder after exercise to minimize inflammation and pain after exercise.

• Frozen shoulders can be resistant to treatment.
• Arthroscopic surgery and manipulated treatments are the surgery optoins for frozen shoulder 
• Other treatments such as release of the scar tissue by arthroscopic surgery or manipulation of the scarred shoulder under anesthesia may be considered for patients with resistant frozen shoulders.
• The manipulation is performed to physically break up the scar tissue of the joint capsule. This procedure carries the risk of breaking the arm bone (humerus fracture). It is very important for patients that undergo manipulation to partake in an active exercise program for the shoulder after the procedure.
• It is only with continued exercise of the shoulder that mobility and function is optimized. Once initial treatments have been initiated, the proper ongoing treatment is guided by the monitoring of your doctor.

Depending on the duration and severity of the frozen shoulder, full recovery is anticipated. Resistant situations can, however, leave permanent loss of range of motion of the shoulder.

Avoiding reinjuring the shoulder because it is essential to maintaining optimal long-term function of the shoulder. A continued, balanced exercise regimen can help to reduce the risk of further shoulder injury.