By: ET Mejia, MD
Frozen shoulder is a common cause of shoulder pain. It is poorly understood, and unfortunately, it is often missed or misdiagnosed and treated inappropriately. The frozen shoulder is characterized by stiffness and loss of shoulder range of motion accompanied by progressive shoulder pain. Sometimes the pain can be quite debilitating and significantly affect function and even sleep. Another term for “frozen shoulder” is adhesive capsulitis, although I believe that arthrofibrosis is a better diagnosis. “Arthro” means joint, and “fibrosis” means scarring or contraction.
There are 2 main causes for shoulder stiffness and loss of joint motion: the frozen shoulder and an arthritic shoulder. The distinction is easily made by a simple x-ray. The frozen shoulder looks normal on x-ray, but the arthritic shoulder shows deformities, spurs and loss of normal joint space. The treatments are quite different for either condition, so it is important to get it right.
Frozen shoulder commonly presents after a minor event or “tweak” that creates a smoldering discomfort and progressive motion loss, but it can also be a result of a significant shoulder injury, a fracture, or after surgery. Prolonged immobilization can predispose to frozen shoulder, although only some people get it and others don’t. We know that diabetics have a higher incidence of frozen shoulder and can be more difficult to treat, although there are other conditions that can predispose to it as well.
In frozen shoulder, the ligaments that hold the joint together “shrink-wrap” and become thickened, so the shoulder gets progressively tighter. Patients lose the ability to reach behind their back, to reach overhead, or to rotate their arm. Early on, there is usually significant inflammation in the joint causing the accompanying pain. Frozen shoulder can eventually burn itself out, but the amount of time that it can take to resolve can be unacceptable and sometimes leads to permanent motion deficits.
The good news is that frozen shoulder can be effectively treated. It requires a dedicated stretching program, which is best managed by a well-trained therapist and monitored by your orthopedic specialist. I tell my patients to think of the frozen shoulder as a piece of new leather that over time gets soft and pliable, like a catcher’s mitt. Oral anti-inflammatories are very helpful, and sometimes a steroid injection is necessary.
Most patients will see gradual improvement in motion and improvement in shoulder pain. This may take several months. Occasionally, the conservative program may not be successful and surgery may be indicated. Surgery is highly effective, although most patients achieve excellent recovery without it. The rehabilitation after surgery is just as important as the surgery itself and requires significant dedication. The prognosis for frozen shoulder is very good, but all partners (patient, surgeon, therapist) in the treatment must be fully committed. At Sports Medicine Center, we have developed a highly effective program to treat this common condition.
DID YOU KNOW? Our ambulatory surgery center, Arthroscopic Surgery Center, is the first free-standing orthopedic surgery center in northeast Wisconsin, established in 2001. Since then, other orthopedic surgery centers have been established, but we are proud to be the first. We are accredited by Medicare and AAAHC, the Accreditation Association for Ambulatory Health, which certifies the highest levels of safety and quality standards.
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