By Scott Gibson, DO, Orthopaedic Shoulder and Sports Surgeon
A frozen shoulder, also known as adhesive capsulitis, may be a cause of your shoulder pain. It usually occurs slowly over time, and it can limit the functional use of your arm. Contrary to its name (and fortunately for Flagstaffians) snow and ice have nothing to do with a frozen shoulder!
When you have a frozen shoulder, shoulder pain and tightness make it difficult to reach overhead to perform simple activities like putting away dishes or combing your hair. Men might have a hard time reaching into their back pocket to grab their wallet. Women may have difficulty reaching behind their back to fasten a bra. Putting on a belt may be painful as well.
The condition can be serious and tends to get worse with time if not treated. It typically affects people between the ages of 40 to 60, and women more often than men. Strangely, medical sciences have not identified the causes, but an inflammatory process is involved. Sometimes freezing occurs because the shoulder has been immobilized from injury, surgery or illness. In many cases, the cause is less obvious. Fortunately, the shoulder can usually be unfrozen, though a full recovery takes some time.
The characteristic symptoms include pain and progressive stiffness. First, the shoulder is painful, but range of motion is still maintained. As the condition progresses, range of motion begins to decrease. By the time the shoulder eventually becomes “frozen,” much of the pain has resolved. It may no longer cause as much pain, but you have difficulty moving your shoulder at all.
The good news is that frozen shoulder resolves on its own – but left untreated, the entire cycle, from early symptoms to recovery, can last from nine months to two years. However, seeking treatment can often significantly shorten this timeframe.
Frozen shoulder has three stages:
- Freezing – The slow, development of pain and stiffness. Over time, you notice the shoulder loses more of its range of motion. During this period, the inflamed shoulder can be very painful. Steroid injections spaced several weeks apart, help ease the discomfort and decrease the inflammation.
- Frozen – The pain begins to dissipate, but range of motion is the most limited. You can do light chores and carry some weight on that side of your body, but it is hard to lift your arm overhead. You often have difficulty with everyday movements, like dressing or reaching into your back pocket.
- Thawing – Stiffness slowly goes away as the shoulder begins to heal. This is when you begin stretching exercises and formal therapy to help restore flexibility and range of motion.
Treatment is focused on relieving pain and restoring the shoulder’s normal range of motion. Your physician may recommend an anti-inflammatory medication such as aspirin, ibuprofen (Motrin, Advil), or naproxen (Aleve). An ice pack applied to the shoulder for 10 to 15 minutes several times a day also can help with pain. You may be given a corticosteroid injection into the shoulder joint. But the key of treatment is physical therapy, concentrating first on exercises that stretch the joint capsule, and later, on strengthening exercises. If your symptoms are not relieved by therapy and other conservative methods, your doctor may discuss surgery. The goal of surgery is to stretch and release the stiffened joint capsule. The most common methods include manipulation under anesthesia and shoulder arthroscopy.
If you think you have a frozen shoulder or are developing one, see your primary care provider or consult with a shoulder expert for a physical exam. To assess your shoulder’s range of motion, he or she will ask you to perform various movements with your arm, such as reaching across your chest to touch the opposite shoulder or down your back to touch the opposite shoulder blade. He or she may take X-rays to make sure there are no other underlying problems, such as arthritic changes. An MRI may be ordered to check for a rotator cuff tear, labral tear or other injuries.
Whatever you do, don’t ignore a frozen shoulder, especially if it is preventing you from carrying out daily activities. Shoulder specialists at Northern Arizona Orthopaedics are available to assist in restoring your shoulder function and help alleviate your pain.
Dr. Scott Gibson is an orthopaedic surgeon specializing in Shoulders and Sports Medicine at Northern Arizona Orthopaedics and Urgent Ortho. He helps people from all athletic abilities recovery from injury and return to active lives. To learn more or to request an appointment from Gibson, visit northAZortho.com or call 928-226-2900.