Frozen shoulder is a painful musculoskeletal condition characterized by pain, stiffness, and limited shoulder joint movement. The more painful it is, the more the patient does not want to move it; that’s why it’s called “frozen.”
The medical term for frozen shoulder is adhesive capsulitis. It usually affects those who are 40 to 60 years old. Likewise, women are more predisposed to develop the condition compared to men. Patients who have diabetes and those recovering from an illness that hinders them from moving their arm are also at risk.
How does frozen shoulder develop?
The shoulder joint connects three bones: the collarbone, the shoulder blade, and the upper arm bone. The latter is attached to a socket in the shoulder blade. The shoulder joint is surrounded by a strong band of connective tissue called the shoulder capsule and lubricated by synovial fluid to move smoothly.
In patients with a frozen shoulder, the shoulder capsule has become thick and rigid. Bands of scar-like tissue called adhesions have developed in the shoulder capsule, making it tighten around the shoulder joint and limit movement.
What is the main cause of a frozen shoulder?
In some cases, the exact cause of a frozen shoulder is hard to pinpoint. However, the following factors appear to contribute to its development:
- Diabetes
The exact reason why diabetic patients are more likely to suffer from a frozen shoulder is unknown. Frozen shoulder patients who are also diabetic experience worse stiffness than those who aren’t.
- Limited shoulder movement
Prolonged immobilization, usually after a stroke, arm fracture, or surgery, can increase your risk for frozen shoulder.
- Other diseases
Heart disease, tuberculosis, and thyroid disorders also increase a person’s risk to develop the condition.
What are the first signs of a frozen shoulder?
You’ll initially feel a dull, aching pain in the affected shoulder that gets worse during movement. The shoulder joint may also feel stiff, which will make you not want to move it. The symptoms may be worse at night, making it difficult to sleep.
Frozen shoulder has three phases:
Freezing stage
This is the initial stage that lasts from 2 to 9 months. It is characterized by:
- Shoulder stiffness
- Shoulder pain with intensity increasing overtime
- Pain that worsens at night
- Very limited range of motion in the affected shoulder
Frozen stage
This stage lasts from 4 to 6 months following the freezing stage. During this phase, patients experience the following:
- Pain eases slightly
- Shoulder joint stiffness worsens
- Inability to perform daily activities
Thawing stage
This is the final phase that lasts from 6 to 24 months. During the thawing stage:
- Pain and stiffness gradually improves
- Normal strength and movement slowly return
What to do if you suspect a frozen shoulder?
If you think you might be suffering from a frozen shoulder, you can schedule a consultation at South Florida Orthopedics. Our orthopedic specialist will perform a thorough assessment to arrive at an accurate diagnosis and individualized treatment plan for your condition.
How is a frozen shoulder diagnosed?
During your consultation with our orthopedic doctors, you will be asked about your medical history and signs and symptoms. You may also expect the following questions:
- When did you begin to feel the symptoms?
- What aggravates the symptoms?
- What triggers the symptoms?
- Can you describe the pain? What is it like?
- Can you rate the pain from 1 to 10, 1 being the lowest?
- Have you had a shoulder injury in the past?
- Any recent surgeries that made you restrict shoulder movement?
- Do you have diabetes or other medical conditions?
Physical assessment
After talking to your doctor about your symptoms and medical history, he will perform a physical exam of the affected arm and shoulder. The goal of this assessment is to determine the range of motion and nature of pain.
To check for your passive range of motion, your doctor will move your arm to assess how much it hurts and how far you can move your shoulder. Then, he will check your active range of motion, wherein he will observe you as you move the affected shoulder on your own. He will then note the findings and make a clinical decision.
Laboratory and imaging tests
Although a physical exam is already sufficient to diagnose a frozen shoulder, your doctor may still order imaging tests such as MRI, ultrasound, and X-ray. These tests can confirm the diagnosis and make sure that you are not suffering from other musculoskeletal conditions such as a rotator cuff injury or arthritis. These conditions also lead to pain and limited movement and knowing the exact cause of your symptoms can guide your doctor on what treatment options to recommend.
What are the treatment options for a frozen shoulder?
Frozen shoulder treatment focuses on symptomatic relief and restoring shoulder strength and range of motion. There are three treatment options to choose from:
Non-surgical treatment
- Medication. To help you deal with the pain and swelling, your doctor may prescribe pain relievers like aspirin and ibuprofen.
- Hot and cold compress to minimize the swelling and relieve pain.
- Steroids. Your doctor may inject anti-inflammatory medicines directly into the affected shoulder joint to relieve pain.
- Physical therapy. You will have to undergo physical therapy and perform specific shoulder exercises to restore your range of motion. A physical therapist will instruct and guide you during each session.
Alternative treatment options for a frozen shoulder
There are other alternative options to manage the pain brought by a frozen shoulder. One of these is acupuncture, a form of traditional Chinese medicine that involves the insertion of fine needles into specific points in the body.
Another option is known as transcutaneous electrical nerve stimulation (TENS). This technique is performed by introducing low-voltage electric current into nerve pathways to stimulate the release of endorphins and relieve pain.
Surgical treatment
Like any other condition, surgical treatment is usually the last resort when conservative methods have failed to improve the signs and symptoms.
For a frozen shoulder, surgery becomes an available option during the frozen stage, wherein the pain has eased up, but the stiffness is worse. The surgery aims to address the stiffness by stretching and releasing the stiff shoulder joint capsule.
One option is a non-invasive procedure wherein your doctor will put you under anesthesia. Once you are sedated, he will manually manipulate and stretch your shoulder joint to improve your range of motion.
Your doctor may combine shoulder arthroscopy and shoulder manipulation to achieve the best results.
Arthroscopic surgery for frozen shoulder
Arthroscopic surgery is an elective procedure, which means that you can schedule and prepare for it in advance. The goal of shoulder arthroscopy is to cut through scar tissues and tight adhesions in the joint that limit the movement of your shoulder to improve range of motion and ease the pain.
What to expect before shoulder arthroscopy for frozen shoulder?
Before the surgery, our shoulder surgeon in Miami will ask you about your medical history, current medications, and allergies. He will give you pre-operative instructions on what to do before the surgery to limit your risk. These may include:
- Adjusting or stopping your current medications
- Fasting instructions
- Getting tests done before the surgery
- Arranging for a ride home
He will also discuss with you the associated risks and possible surgical outcome.
What to expect during shoulder arthroscopy?
During the surgery, you will be under anesthesia, so you will not feel any pain. The surgeon will make three small, keyhole incisions in the affected shoulder where the arthroscope will be inserted to access the joint. It is a flexible instrument with a camera and light at the tip to give the doctor a clear view of the joint on a screen.
He will then insert small instruments into the other incisions and cut and remove adhesions and scar tissues. Then, he will remove the surgical instruments and the arthroscope, stitch the incisions, and cover them with a dressing and bandage. The surgery may take 2 hours, depending on the patient’s condition.
What to expect after shoulder arthroscopy for frozen shoulder?
You can go home the same day after the surgery if there are no problems. You may expect pain and swelling in the operated shoulder in the first few weeks post-surgery. Your doctor will also give you post-operative instructions to help manage the pain and swelling and ensure complete recovery.
The instructions may include:
- Taking pain medications
- Elevating the shoulder to relieve swelling
- Applying a cold compress on the area to help ease pain
- Wearing an arm sling
Your surgeon may also recommend getting help with daily activities after surgery. Complete recovery may take 6 months to 2 years. To maximize the surgical outcome, you need to undergo continuous physical therapy and perform passive motion and exercise at home.
Answers to common questions about frozen shoulder
Who needs surgery for a frozen shoulder?
It is rare for frozen shoulder patients to require surgery. However, if your signs and symptoms persist longer than 12 to 18 months despite compliance to conservative treatment, our shoulder surgeon in Miami may recommend surgery as a last resort.
How to prevent a frozen shoulder?
You can help to prevent a frozen shoulder by keeping yourself active. Any injury that may lead to temporary immobility of the shoulder increases your risk to develop this condition. To prevent this, ask your doctor about safe exercises that can help you maintain the range of motion of your shoulder joint.
How long does it take for a frozen shoulder to heal on its own?
Frozen shoulder may gradually resolve on its own even without medical intervention. However, the signs and symptoms often lead to temporary disability and pain that patients need to endure for up to 12-18 months. Sometimes, it’s even longer. In some cases, the normal and full range of motion may never return without proper treatment.
Where to find South Florida Orthopedic specialists near me?
If you think you might be suffering from a frozen shoulder, consult our specialists at South Florida International Orthopaedics.
Our experienced orthopedic surgeons and sports medicine doctors in Miami specialize in minimally invasive surgery and the latest innovative non-surgical treatments. Our goal is to provide you with high-level care that is individualized and customized for your condition.
If you are looking for frozen shoulder treatment in Miami or Homestead, our facility has a team ready and waiting to help with your pain so you can reclaim your life. Request an appointment today!
The material contained on this site is for informational purposes only and DOES NOT CONSTITUTE THE PROVIDING OF MEDICAL ADVICE, and is not intended to be a substitute for independent professional medical judgment, advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare providers with any questions or concerns you may have regarding your health.
