• Frozen Shoulder

      Frozen shoulder is a bit of a mystery in the medical world. Essentially a patient develops stiffness of their shoulder without an inciting event. They just wake up one day with severely limited motion and pain. Patients have difficulty with some of the basic activities of daily living such as tucking in their shirt, fastening a bra, combing their hair and others. The pain can also interrupt sleep. As time goes on the pain can dissipate but the patient is left with stiffness.

      Etiology (Causes) of Frozen Shoulder

      • We do not know why frozen shoulder occurs in 95% of the cases.
      • In the other 5%, patients develop stiffness as a result of trauma, calcium deposits, arthritis, or following surgery if scar tissue forms.
      • Diabetic patients, women and people in their 40s and 50s have a higher risk for developing (being afflicted with) frozen shoulder.
      • It appears that 3% of the population can suffer from frozen shoulder but this number jumps to 10% in diabetic patients.

      Pathology

      So what’s making the shoulder stiff? Every joint has a capsule that encloses the joint and is lined with a layer of cells called synovium. The synovium and capsule become very inflamed which is very painful and limits motion. Then the capsule itself, which is usually paper-thin, starts thickening and that also restricts range of motion in the shoulder. The medical term for frozen shoulder is idiopathic adhesive capsulitis: idiopathic (unknown cause) adhesive (stiff) capsulitis (inflamed capsule).

      Non-operative Management

      Most patients can be successfully treated without surgery but it can take 9 – 12 months to resolve.

      • To start with the inflammation needs to be controlled and that can be with anti-inflammatory medications (NSAIDS) or steroid injection. Some patients may not be able to take these medications and should check with their physician.
      • Next the capsule needs to be stretched and that is best performed with the help and guidance of a physical therapist. A home stretching program is also essential.
      • Using a heating pad before stretching or doing the stretches in a warm shower can help.
      • For diabetic patients keeping their blood sugars controlled is also important.

      Operative Management / Minimally Invasive / Shoulder Arthroscopy

      Some patients don’t get better. They reach a plateau and their shoulder range of motion remains limited, affecting their basic activities of daily living. These patients can benefit tremendously from an arthroscopic (minimally invasive) procedure that releases/removes the thickened capsule. Following surgery patients are able to return to physical therapy and regain most of their motion.