More About Frozen Shoulder

Frozen shoulder happens when inflammation develops inside the shoulder joint.  Frozen shoulder is also called “adhesive capsulitis”.  The inflammation from frozen shoulder causes pain at first, but over time causes thickening of the ligaments inside the shoulder.  This thickening of the ligaments is similar to the formation of a scar.  As this occurs, the shoulder becomes progressively more stiff.  This process occurs slowly over many months.  Most people start to notice that they can’t put their hand behind their back, to put on a bra or put a wallet in the back pocket.  Pain at night is very common, and throwing or reaching above the head become difficult or impossible.  We don’t know why frozen shoulder happens, but it is more common in patients with diabetes or thyroid problems.  Sometimes it starts as the result of a minor injury.  Most often, though, it begins for no reason at all. 

It is not always possible to tell the difference between pain from frozen shoulder or pain from arthritis, bursitis, or tendonitis.  Only your physician can make a definitive diagnosis.

The good news is that frozen shoulder is not a permanent problem.  It will always get better on its own, but slowly, over many months.  It can take up to one or two years for the pain to completely go away and the shoulder motion to return to normal.  Most people don’t want to wait a year for the symptoms to clear up.  So what can be done?

In my practice, I usually start with cortisone shots.  Since the problem is related to inflammation, and cortisone is a powerful anti-inflammatory, cortisone shots help most people get past the worst of the pain and stiffness.  These injections are done with the help of an ultrasound machine, which guides the injection into the correct spot.  Most people will have significant relief of pain with cortisone injections.  Some people, though, may continue to experience stiffness even if the pain improves.

Patients with persistent stiffness sometimes benefit from a simple surgical procedure called a “manipulation and release”.  This procedure is done under general anesthesia.  First, the shoulder is gently stretched to break up the scar tisuue.  Then, through small “arthroscopic” incisions about one-half inch long, the inside of the shoulder is cleaned up and the tight scar tissue is removed.  Most patients recover fully from this surgery within 6 weeks, although it may take longer.  The results are generally very good.

To summarize, frozen shoulder is a problem of inflammation in the shoulder.  It results in pain and stiffness, and is treated with cortisone injections.  If cortisone shots don’t work, then a simple arthroscopic surgical procedure may help.