Better Me

Frozen Shoulder: Don’t ‘Let It Go’ Untreated

Nobody likes to be given the cold shoulder. But what if your own shoulder is giving you an icy reception? It’s definitely not something you should brush off as you may have a condition called frozen shoulder, or adhesive capsulitis.

What causes a frozen shoulder?

Have you started experiencing stiffness, pain and a limited range of movement in your shoulder? It may be as a result of an injury or overuse, certain medical condition, but sometimes, it can be hard to pinpoint its cause.

“Frozen shoulders can be caused by an injury or overuse, which requires the shoulder to be immobilized, but the majority of these seemingly occur without a major injury—and some occur spontaneously,” said Tyler Collins, MD, an orthopedic sports medicine surgeon at TOCA at Banner Health in Arizona. “The only warning sign would be the onset of pain and stiffness of the shoulder for what appears to be for no reason."

While it’s not clear why some develop it and others don’t, some groups may be at greater risk. These include:

  • Those with endocrine disorders, such as diabetes and thyroid disease
  • As a result of a major injury or surgery, where you have to stop using your shoulder in a normal way
  • Those over age 40 and frequently women more often than men (whoever said age is just a number didn’t have to deal with joint pain!)
  • There is also an association with heart disease, pulmonary disease, rheumatoid arthritis and stroke

What are the symptoms of a frozen shoulder?

A frozen shoulder occurs when the connective tissue surrounding the shoulder joint becomes inflamed and stiffens, which restricts shoulder movements. Arm movements can become extremely limited and sometimes even the smallest movements can result in great pain. The pain can be felt around the shoulder but can also run up the neck or down to the elbow.

You’ll typically go through three stages with a frozen shoulder—each with their own symptoms:

  • Freezing: This is the earliest stage where your shoulder is inflamed and developing scar tissue. You will usually have quite a bit of pain as well as stiffness during this stage.
  • Frozen: The frozen stage occurs after the freezing phase when the shoulder capsule is thickened and scarred but is not inflamed. You may be stiff but most pain has subsided. However, there may be some pain with aggressive stretching.
  • Thawing: As this implies, the thawing stage is when the shoulder begins to recover and gradually you begin to regain full strength and range of motion.

How is a frozen shoulder diagnosed?

Diagnosing a frozen shoulder requires only history and a physical exam. They’ll check to see how badly it hurts, your active range of motion, your passive range of motion (when they move it for you) and will note the difference.

A physical exam is typically enough to diagnose frozen shoulder, but they may order an X-ray to rule out other problems like arthritis.

“Arthritis is the only other shoulder condition which can cause lack of passive range of motion,” Dr. Collins said. “Generally, with arthritis, there is a gradual onset over months to years of pain and loss of motion, whereas in a frozen shoulder this occurs quicker. An X-ray can definitively differentiate between arthritis and a frozen shoulder if needed, but an MRI is not necessary to make the diagnosis.”

How is a frozen shoulder treated?

The good news is that a vast majority of frozen shoulders respond well to nonsurgical treatments. The focus of treatment is to control pain and restore motion and strength, but Dr. Collins warns patients to be very patient.

“For most people all that is needed is a good stretching program and a lot of patience as there is no quick-fix cure,” Dr. Collins said. “Most patients improve with a simple regimen of stretching or physical therapy and over-the-counter anti-inflammatory medicines to control pain. If pain persists, then a steroid injection can be very helpful.”

When is surgery recommended?

The need for shoulder surgery is less common but may be an option if conservative treatments have failed to treat pain and symptoms.

“I always recommend patients try at least three months of a stretching program or physical therapy and only recommend surgery if the patient plateaus at an unacceptable range of motion or the recovery is taking too long for their liking,” Dr. Collins said. “It is important to note that surgery or manipulation is generally not successful if performed during the freezing phase, as the persistent inflammation puts the shoulder at high risk of redeveloping scar tissue.”

What is the long-term outlook for those with a frozen shoulder?

There is a reason some say, “Patience is a virtue.” A frozen shoulder can put that to the test.

Though it can be slow and tedious, most patients do well and report decreased pain and near normal range of motion after conservative treatment. However, it isn’t uncommon for some to have some residual discomfort or stiffness – but usually this is mild.

If your shoulder is giving you the ‘cold shoulder,’ don’t let it go. Schedule an appointment with a Banner Health expert. Whether you’re a casual athlete, weekend warrior or professional athlete, our sports medicine doctors provide services for everyone. Visit bannerhealth.com to learn more.

Orthopedics Fitness Sports Medicine

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