The term “frozen shoulder” refers to pain, stiffness, and loss of normal range of motion in the shoulder joint. While the cause of frozen shoulder is not fully understood, it is believed that most cases are related to overuse or acute injuries of the shoulder. As a result of this overuse or trauma, the tissues surrounding the shoulder joint become inflamed, resulting in pain and stiffness. As movement becomes more restricted, the connective tissue surrounding the joint capsule thickens and contracts, making movement even more difficult and painful. Eventually, the joint becomes so stiff that the range of motion is severely limited. If not treated, the condition will worsen and may lead to serious disability.
Frozen shoulder primarily affects people between the ages of 40 and 60, and it occurs more often in women than men. Diabetics and individuals with thyroid disorders, cardiovascular disease, or Parkinson’s disease are at increased risk of developing frozen shoulder, and about 10% of people with rotator cuff disorders will develop it as well. Medical issues that result in forced immobility, such as a stroke, heart conditions, or surgery, can also cause frozen shoulder.
Both nonsurgical and surgical options are employed to treat frozen shoulder. Generally, surgery is recommended only after non-surgical options fail.
Nonsurgical options include the use of pain relievers and anti-inflammatory medications, icing of the joint, and physical therapy. In some cases, care providers may recommend cortisone injections into the shoulder joint or surrounding soft tissue, or hydrodilatation, which involves injecting sterile fluid into the shoulder joint to stretch the joint capsule.
While most nonsurgical options address the pain and stiffness common to the disorder, physical therapy focuses on restoring shoulder mobility. Generally, stretching and range of motion exercises are used to help the patient regain strength and full use of the shoulder.
Experts say that more than 90% of individuals with frozen shoulder improve after nonsurgical treatment, but the process is a long one. Full recovery from a frozen shoulder can take several months to several years. For the 10% of patients who do not improve with nonsurgical treatment, surgery becomes an option.
A common surgical treatment for frozen shoulder is arthroscopic capsular release. Guided by a small camera inserted into the shoulder joint, a surgeon makes small incisions into the tight portions of the joint capsule, which surrounds the shoulder socket. This gives the socket more freedom to move. To ensure continued shoulder mobility, a continuous passive motion machine may be used to keep the shoulder stretched. In addition, physical therapy will be required to ensure scar tissue does not form around the joint.
Most shoulders that fail nonoperative treatment can be cured with manipulation under anesthesia. While the patient is asleep, a surgeon gently manipulates the shoulder joint to force the joint capsule to stretch or tear. This releases the tight shoulder and increases the range of motion. Physical therapy is resumed immediately following manipulation.
A third surgical option is open capsular release, although its use has declined since the introduction of arthroscopic surgery. During this procedure, the joint capsule is split so that the surgeon can look inside the shoulder joint and make the necessary incisions to increase mobility. Experts believe arthroscopic capsular release is less invasive and less painful. It also provides better access to the shoulder joint.
After all types of surgery, physical therapy is required to maintain the range of motion. Recovery times range from six weeks to three months. Most patients who undergo surgery for frozen shoulder make a complete, permanent recovery from the condition. However, those with certain medical conditions, such as diabetes, may continue to experience some stiffness, and there is a slight chance that the condition may return.
“Frozen Shoulder,” OrthoInfo (American Academy of Orthopaedic Surgeons), https://orthoinfo.aaos.org/en/diseases--conditions/frozen-shoulder
“Frozen Shoulder Surgery Overview: Arthroscopic Capsular Release for Frozen Shoulder,” VeryWell Health, https://www.verywellhealth.com/arthroscopic-capsular-release-frozen-shoulder-surgery-2549883
“How to release a frozen shoulder,” Harvard Women’s Health Watch, https://www.health.harvard.edu/pain/how-to-release-a-frozen-shoulder
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