Frozen shoulder, or adhesive capsulitis, is a relatively common cause of disabling shoulder pain and dysfunction. When a patient comes into my office with severe pain in the shoulder, this diagnosis is always at the top of my list as I begin to evaluate their shoulder. Although it is not as common as a rotator cuff problem, the pain it causes is typically much more severe.
Frozen shoulder affects about 3-5% of the general population and tends to affect patients between 40 and 60 years of age. The cause of this problem is not well understood, but it involves scarring and contracture of the joint capsule which ends up limiting the mobility of the shoulder joint.
Many of those affected by frozen shoulder do not have any predisposing conditions, but it is much more common in patients with diabetes, hypo- or hyperthyroidism, cardiovascular disease, fibrocystic breast disease and Parkinson’s disease. It can also develop following trauma to the shoulder.
The hallmark physical exam finding of frozen shoulder is severe loss of passive and active mobility of the shoulder joint. Patients often do not appreciate the significant loss of motion as it usually develops slowly and they unconsciously compensate by using more shoulder blade motion.
The good news regarding frozen shoulder is that it will usually get better without any formal treatment. The bad news is that it can take a very long time (up to several years), and patients symptoms will often trigger them to seek treatment to shorten the course of this problem.
Conservative treatments including physical therapy for joint mobilizations, oral non- steroidal medications and steroid injections can help improve the pain level and restore functional motion. The primary objective in the treatment of frozen shoulder is to control pain while the problem resolves on its own. Greater than 90% of patients improve with these conservative treatments.
When the pain and functional limitations are not responding to appropriate conservative measures, surgery can be considered to restore the mobility which will treat the pain as well. Surgery is performed as an outpatient and typically arthroscopy is used. Arthroscopy involves a minimally invasive approach to the shoulder joint using a camera and specially designed instruments that are inserted into the joint via several 1/4” incisions. The instruments are utilized to cut and remove the scar tissue that is restricting movement. This approach is very effective in restoring normal or near normal range of motion.
Following surgery of this kind, the arm is kept out of the sling and full range of motion is encouraged from the day of surgery. Daily physical therapy is typically prescribed for the first couple weeks after surgery to help maintain the motion attained during surgery. This procedure is effective in restoring and maintaining the motion of the shoulder in over 90% of the cases that require surgery.
If you believe that you are suffering from a frozen shoulder, I would be happy to evaluate your shoulder and offer treatments. Please call my office at (719) 822-6277 to request an appointment.
