Shoulder > Frozen Shoulder

What is Frozen Shoulder?

The shoulder joint is formed by the junction of three bones: the shoulder blade (scapula), upper arm bone (humerus), and collarbone (clavicle). The middle of the shoulder blade is shaped like a socket and the top of the shoulder blade forms a roof. A water-tight bag composed of ligaments and joint fluid attaches the three bones to each other to form the shoulder joint capsule, which maintains the basic shape of the shoulder joint. Frozen shoulder, the common term for adhesive capsulitis, is a condition that occurs when your shoulder joint capsule becomes inflamed and its tissues contract or stick together. This can cause the joint capsule to tighten, producing pain and a gradual loss of motion, or "freezing," of your shoulder.

There is no single cause of frozen shoulder, and there is debate over which factors do cause this condition. While it is rarely caused by acute trauma, it may stem from an injury to another part of the body that requires the shoulder to be immobilized – for example, a wrist injury in which the shoulder is placed in a sling. Thyroid disease and diabetes also may be associated with frozen shoulder. It has been theorized that frozen shoulder may be caused by an autoimmune reaction, in which the body mistakenly attacks its own tissue, causing an inflammatory reaction.

Women make up approximately 70 percent of frozen shoulder cases, and the condition generally affects people between the ages of 40 and 60. 90% of all patients are cured with non-operative treatment, including NSAID'S and a physical therapy stretching program. As motion pf the shoulder improves, pain resolves. 10% of patients are not cured with an exercise program and benefit from manipulation of the shoulder under anesthesia and arthroscopic release of the contracted soft tissue.

There usually are three parts to an orthopedic evaluation: medical history, a physical examination, and tests that your physician may order. Your physician will ask specific questions, particularly regarding any activities that may have caused your pain. You will be asked when the soreness or pain began, where in your shoulder it occurs, and, most important, if you have noticed any decrease in your shoulder’s range of motion since the onset of pain. You also will be asked if have had any prior shoulder injuries, and about any treatments you have tried in the past. Physicians also typically ask about other conditions, such as arthritis, diabetes, and thyroid disease, and medications currently being taken. You may also be asked about your physical and athletic goals – information that will help your physician decide what treatment might be best for you in achieving those goals.

To differentiate frozen shoulder from other shoulder injuries such as impingement syndrome or rotator cuff tears, your physician will closely examine your shoulder’s range of motion during a variety of arm motions, both assisted and unassisted. For example, if you are unable to make certain arm movements on your own but are able to do so with your physician’s assistance, you may have suffered a rotator cuff tear. This can also be determined by a manual test of your rotator cuff muscles. Another test your physician may perform is to press down on your shoulder blade (scapula) while rotating your arm internally and externally.

Your physician will order X-rays to rule out any abnormalities in your shoulder. In addition, MRI (magnetic resonance imaging) may be used to rule out other underlying conditions as sources of pain and inflammation, such as impingement or a rotator cuff tear.