All About The Frozen Shoulder
The disorder affects the most flexible joint in the body known as the glenohumeral joint. This “ball and socket” joint connects the arm to the trunk. The joint is extremely mobile due in part to its very shallow socket and the overlying capsule- which has built in redundancy and elastic flexibility (Figure 1).Adhesive capsulitis typically starts absent any trauma or illness as a painful shoulder with gradual onset of stiffness, which can vary from mild to profound. For reasons unclear the shoulder joint capsule becomes inflamed, swollen, and stiff. As the inflammation subsides scar tissue forms causing the capsule to stiffen and shrink- thereby preventing normal shoulder motion.
Typically patients present with a shoulder that is mildly painful or asymptomatic at rest, yet sharply painful at the end ranges of a restricted motion. Patients note an inability to reach fully overhead and especially behind them. Patients complain of a sudden inability to dress comfortably, reach for a seatbelt, fasten a brassiere, or reach to an overhead cupboard. Putting an arm into a jacket sleeve is now a reported issue (Fig 2).
The cornerstone of treatment starts with an accurate diagnosis, as many other conditions can cause stiffness to a shoulder and need to be ruled out. Such conditions may include trauma, rotator cuff tears, labral tears, calcific tendonitis, arthritis, inflammatory and rheumatologic disorders, or less frequently infections or neurological conditions.
Fortunately, most cases of adhesive capsulitis respond to non-operative treatment and resolve with minimal residuals in three to twelve months. Treatment starts with an orthopedic visit where an appropriate history, physical exam, and X-Ray will typically confirm the diagnosis. MRI testing not often necessary or meaningful in this disorder.
The orthopedist would usually advise the patient on a home exercise program, a course of physical therapy, and perhaps a non-narcotic pain reliever or anti-inflammatory medication to allow initial tolerance to the stretching program. Often times an ultrasound guided intra-articular injection provides significant relief and an early partial return of motion. In a small percentage of patients with severe stiffness recalcitrant to non-operative modalities, surgery may be offered which would include a manipulation under anesthesia with or without an arthroscopic removal of scar tissue.
If your shoulder is painful or not functioning properly- plan a visit with a board certified orthopedic surgeon so you can get “back in the game”!
Robert V. Moriarty MD FAAOS
Orthopedics and Sports Medicine
755 NY Ave Huntington, NY 11743