Frozen Shoulder

What frozen shoulder is

Every joint is enclosed in a capsule, a sleeve of tissue that keeps the joint fluid in and normally has enough slack to permit a full range of movement. In the shoulder that slack is generous, which allows the arm to reach in almost any direction. In frozen shoulder the capsule becomes inflamed and then fibrotic, losing its folds and shrinking around the joint. The result is mechanical: the arm is held back by tissue that has become too short, not by pain or weakness. If someone else lifts and rotates your arm, the motion is still restricted, because the restraint is in the capsule itself.

The condition is often divided into two groups. The primary form arises without an obvious cause and is recognized to occur more often in people with diabetes and thyroid conditions. The secondary form follows something identifiable: a fracture, a rotator cuff problem, surgery, or a period in which the arm was kept still in a sling. Clinicians describe the condition as passing through stages: pain dominates while motion is lost, then the shoulder is stiff but less painful, and eventually it loosens. These stages describe a pattern rather than a schedule, and experiences vary.

Symptoms that often bring people in

• A shoulder that has become progressively harder to move, with no injury to explain it.
• Pain over the outer arm, sharp when the arm is moved past its limit.
• Marked difficulty rotating the arm outward, for instance reaching for something beside you.
• Trouble reaching behind the back, or getting a wallet from a back pocket.
• Night pain, and compensating with the trunk to make a movement the shoulder cannot.

How it is evaluated

Frozen shoulder is largely a clinical diagnosis, and the examination is what establishes it. The examiner measures how far you can move the arm yourself, then how far it can be moved for you, and looks for the characteristic finding of both being limited to a similar degree, with outward rotation particularly restricted. That pattern separates it from a rotator cuff tear, in which passive motion is better preserved. Plain X-rays are typically taken, not to show the capsule, which does not appear on them, but to rule out arthritis or an old fracture. A physician will also ask about diabetes, thyroid function and recent immobilization.

Treatment options in general terms

Most frozen shoulders are managed without an operation, controlling pain while gradually restoring the length of the capsule.

• Guided stretching and physical therapy. A program worked at a level the shoulder tolerates, since sessions that are too aggressive during the inflamed phase can worsen pain.
• Pain control. Medication categories that make it possible to keep moving the arm and to sleep.
• Injections. Corticosteroid injection into the joint, particularly while pain is the dominant problem.
• Hydrodilatation. An image guided procedure in which fluid is used to expand the tight capsule.
• Attention to associated conditions. Management of diabetes or thyroid disease with your primary physician.

When stiffness persists and function remains limited despite these measures, procedural options may be raised.

• Manipulation under anesthesia. The arm is moved through its range while you are asleep to release the contracted capsule.
• Arthroscopic capsular release. The tight portions of the capsule are divided through small incisions, usually followed by rehabilitation to maintain the motion gained.

What to expect when you consult Dr. Wolfson

Dr. Wolfson, MD, FRCSC, FACS, will begin by establishing whether stiffness is truly coming from the capsule or another source, since the treatments differ. He will measure your motion and explain where in the course of the condition your shoulder appears to be. He speaks English, Russian, Arabic and Hebrew, which helps when a condition needs close communication over a series of visits.

This page provides general information about frozen shoulder and is not medical advice. It is not a substitute for examination, imaging and diagnosis by a qualified physician. Every case is different and requires individual evaluation. If you have severe pain, an obvious deformity, loss of function, fever, or an injury from a significant accident, seek medical care promptly.

Contact Dr. Wolfson if you would like to setup an appointment. If you are a new patient, please book all in-person appointments with Dr. Wolfson via telephone.

If you live outside of the San Francisco Bay Area, you can request a complimentary phone consultation with Dr. Wolfson to assess your case. Please call or e-mail us to set up your complimentary consultation.

Call: (415) 221-4400

E-mail: [email protected]