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www.mayoclinic.com/health/frozen-shoulder/DS00416

Frozen Shoulder(Adhesive Capsulitis)

Medical Author: William C. Shiel r.! MD! "AC#! "AC$Medical %ditor:Denni& 'ee! MD

What i& a frozen &houlder(

What cau&e& a frozen &houlder(

)ow i& a frozen &houlder dia*no&ed(

What condition& can mimic a frozen &houlder(

)ow i& a frozen &houlder treated(

"rozen Shoulder At A +lance

Find a local ,rthoedic Sur*eon in our town

What is a frozen shoulder?

A frozen &houlder i& a &houlder oint with &i*nificant lo&& of it& ran*e of motion in all direction&. he ran*e ofmotion i& limited not onl when the atient attemt& motion! ut al&o when the doctor attemt& to mo2e the oint

full while the atient rela3e&. A frozen &houlder i& al&o referred to a& adhe&i2e ca&uliti&.

What causes a frozen shoulder?

"rozen &houlder i& the re&ult of inflammation! &carrin*! thicenin*! and &hrina*e of the ca&ule that &urround&the normal &houlder oint. An inur to the &houlder can lead to frozen &houlder! includin*tendiniti&! ur&iti&!androtator cuff inur. "rozen &houlder& occur more fre5uentl in atient& with diaete&! chronic inflammator arthriti&of the &houlder! or after che&t or rea&t &ur*er. 'on*-term immoilit of the &houlder oint can ut eole at ri&

to de2elo a frozen &houlder.

How is a frozen shoulder dianosed?

A frozen &houlder i& &u**e&ted durin* e3amination when the &houlder ran*e of motion i& &i*nificantl limited! witheither the atient or the e3aminer attemtin* the mo2ement. nderlin* di&ea&e& in2ol2in* the &houlder can e

dia*no&ed with the hi&tor! e3amination! lood te&tin*! and 3-ra e3amination of the &houlder.

7f nece&&ar! the dia*no&i& can e confirmed when an 3-ra contra&t de i& inected into the &houlder oint todemon&trate the characteri&tic &hrunen &houlder ca&ule of a frozen &houlder. hi& 3-ra te&t i& called

arthro*rah. he ti&&ue& of the &houlder can al&o e e2aluated with an M$7 &can.

What conditions can mimic a frozen shoulder?

7nflammation of the &houlder oint 8arthriti&9 or the mu&cle& around the &houlder can cau&e &wellin*! ain! or&tiffne&& of the oint that can mimic the ran*e of motion limitation of a frozen &houlder.

7nur to indi2idual tendon& around the &houlder 8tendon& of the rotator cuff9 can limit &houlder-oint ran*e ofmotion! ut u&uall not in all direction&. ,ften durin* the e3amination of a &houlder with tendon inur 8tendiniti&

or tendon tear9! the doctor i& ale to mo2e the oint with the atient rela3ed eond the ran*e that the atient canon their own.

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How is a frozen shoulder treated?

he treatment of a frozen &houlder u&uall re5uire& an a**re&&i2e comination of antiinflammator medication!corti&one inection8&9 into the &houlder! and h&ical thera. Without a**re&&i2e treatment! a frozen &houlder

can e ermanent.

Dili*ent h&ical thera i& often e and can include ultra&ound! electric &timulation! ran*e-of-motion e3erci&emaneu2er&! ice ac&! and e2entuall &tren*thenin* e3erci&e&. #h&ical thera can tae wee& to month& for

reco2er! deendin* on the &e2erit of the &carrin* of the ti&&ue& around the &houlder.

7t i& 2er imortant for eole with a frozen &houlder to a2oid reinurin* the &houlder ti&&ue& durin* therehailitation eriod. he&e indi2idual& &hould a2oid &udden! erin* motion& of or hea2 liftin* with the affected

&houlder.

Sometime& frozen &houlder& are re&i&tant to treatment. #atient& with re&i&tant frozen &houlder& can econ&idered for relea&e of the &car ti&&ue arthro&coic &ur*er or maniulation of the &carred &houlder underane&the&ia. hi& maniulation i& erformed to h&icall rea u the &car ti&&ue of the oint ca&ule. 7t carrie&

the ri& of reain* the arm one 8humeru& fracture9. 7t i& 2er imortant for atient& that under*o maniulation toartae in an acti2e e3erci&e ro*ram for the &houlder after the rocedure. 7t i& onl with continued e3erci&e of

the &houlder that moilit and function i& otimized.

Frozen Shoulder At A !lance

"rozen &houlder i& the re&ult of &carrin*! thicenin*! and &hrina*e of the oint ca&ule.

An inur to the &houlder can lead to frozen &houlder.

A frozen &houlder i& u&uall dia*no&ed durin* an e3amination.

A frozen &houlder u&uall re5uire& a**re&&i2e treatment.

$%"%$%C%S:

;ooman! William! et al.! ed&. Clinical Primer of Rheumatology. #hiladelhia: 'iincott William& < Wilin&! =00>.

Kelley's Textbook of Rheumatology! W ? Saunder& Co! edited Shaun $udd! et al.! =000.

Last Editorial Review !"#!!#"$$%

htt#wwwmedicinenetcom#fro(en)shoulder#articlehtm

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Adhesive Capsulitis

Adhesive Capsulitis, or a frozen s houlder, is a poorly understood condition in

which the deepest layers of soft tissue, called the joint capsule, become

diseased. Shoulder range of motion becomes very li mited and painful. The

cause of a frozen shoulder is still not known but minor traumas,

hyperthyroidism, diabetes, psychiatric patients, postsurgical patients, and

prolonged immobilization of the shoulder may in someway cause t his

condition. The disease is characterized as having freezing, frozen, and

thawing stages, and is selflimiting ! in time it goes away on its own". #owever,

it can take two years or more to recover from this condition.

$hysical therapy consisting of patient education, stretching, joint

mobilization, and a home e%ercise progr am can help speed recovery. &or a

small percentage of frozen shoulder patients, it may take two years or more to

recover.

htt#www&hysicalthera&yflagstaffcom#library)shoulder)"*

Frozen shoulder (adhesive capsulitis)

"rozen &houlder! al&o nown a& adhe&i2e ca&uliti&! i& a di&order characterized ain! &tiffne&&! and lo&& of ran*e of motion in the &houlder. 7t affect& aout twoercent of the *eneral oulation! and it i& mo&t common in women who are o2er 40ear& of a*e.

"tioloy

he cau&e& of frozen &houlder are not full under&tood. he roce&& in2ol2e&

thicenin* and contracture of the &houlder oint ca&ule. he roce&& doe& not occurin an other oint in the od. "or rea&on& unown! the nondominant &houlder i&

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affected more often than the dominant one. "rozen &houlder i& not normalla&&ociated with calcium deo&it&! rotator cuff inurie&! arthriti& or mali*nancie&. he3-ra& of the &houlder are comletel normal.

Medical rolem& a&&ociated with increa&ed ri& of frozen &houlder include diaete&!

throid di&ea&e! #arin&on@& di&ea&e! and cardiac di&ea&e. "rozen &houlder affect&aout 10 to =0 ercent of eole with diaete&! therefore a wor-u for diaete& orother di&order& ma e recommended if a frozen &houlder occur&.

Another ri& facter for de2eloment of frozen &houlder i& rolon*ed immoilization.After an inur to the &houlder! earl motion i& u&uall recommended 8a&&umin* thatthe &houlder i& &tale9 in hoe& of a2oidin* the de2eloment of a frozen &houlder.

#ianosis

hi& condition i& dia*no&ed a doctor a&ed on the hi&tor of the atient@&

&mtom& and h&ical e3amination. -ra& or M$7 8ma*netic re&onance ima*in*9&tudie& are &ometime& u&ed to rule out other cau&e& of &houlder &tiffne&& and ain!&uch a& rotator cuff tear.

Symptoms

he hallmar of frozen &houlder i& ain with re&tricted motion of the &houlder. heain i& u&uall dull or achin*. 7t u&uall ecome& wor&e with motion! and it limit& theatient@& u&e of the affected &houlder and arm. Motion i& al&o limited when &omeoneel&e attemt& to mo2e the &houlder for the atient! a& when a doctor erform& a

h&ical e3am. Some h&ician& ha2e de&cried the normal cour&e of a frozen&houlder a& ha2in* three &ta*e&. %ach &ta*e ha& een reorted to la&t rou*hl 4month&! ut the time frame for each atient can e hi*hl 2ariale.

Stae $%Durin* the Bfreezin*B &ta*e the atient *raduall de2elo& a ainful

&houlder. A& the ain wor&en&! the &houlder lo&e& motion.

Stae &%he ain &lowl &u&ide& durin* the BfrozenB &ta*e! ut the limited

ran*e of motion remain&.

Stae '%Durin* the Bthawin*B &ta*e the &houlder motion &lowl return&

toward normal.

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Conservative reatment

"rozen &houlder will *enerall imro2e without &ur*er. reco2er roce&&! howe2er! can e ainfull &low 8occa&i

u to two to three ear&9.

A er&on with a &tiff and ainful &houlder &hould &ee ah&ician to en&ure that no other inurie& or illne&&e& arere&ent.

reatment i& focu&ed on ain control and re&toration of m#ain control can e achie2ed with anti-inflammatormedication& 8iurofen! naro3en! a&irin! etc.9 a& well a&inectioned cortico&teroid&. #h&ical thera ma hel a to re*ain &houlder motion. Stretchin* or ran*e-of-motion

e3erci&e& for the &houlder ma e done at home or with ta&&i&tance of a h&ical therai&t. %3amle e3erci&e& arein "i*ure& 1! =! and >. A h&ical therai&t can ro2ideadditional e3erci&e&! a& well a& other treatment& &uch a&ma&&a*e and heat. 7f the atient doe& not re&ond to the&treatment&! ner2e loc& ma e tried to minimize ain anallow for more a**re&&i2e h&ical thera.

Mo&t atient& imro2e with the&e &imle treatment&. )owin &ome ca&e& the motion doe& not return comletel e2eafter &e2eral ear&. "ortunatel! thi& lo&& i& u&uall &malldoe& not cau&e functional limitation&.

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Surical reatment

he 2a&t maorit of indi2idual& will *et etter if *i2en &ufficient time! &o &ur*er i& not

often re5uired. Sur*ical inter2ention i& con&idered onl after an aroriate cour&e ofh&ical thera and anti-inflammator medication& ha& failed.

Sur*ical inter2ention i& aimed at &tretchin* or relea&in* the contracted oint ca&uleof the &houlder. hi& u&uall con&i&t& of maniulation under ane&the&ia and/or&houlder arthro&co:

Maniulation under ane&the&ia 8"i*ure 49 in2ol2e& uttin* the atient to &lee!

then *entl and &lowl forcin* the &houlder to mo2e. hi& roce&& cau&e& theca&ule to &tretch! and &oft ti&&ue adhe&ion& are roen.

With &houlder arthro&co! the &ur*eon mae& &e2eral &mall inci&ion& around

the &houlder. A &mall camera 8&coe9 and in&trument& are in&erted throu*hthe inci&ion&. he oint ca&ule i& 2iewed with the &coe! and the ti*ht ortion&of the oint ca&ule are relea&ed

,ften! maniulation and arthro&co are u&ed in comination to otain a full ran*e ofmotion for the &houlder oint. Mo&t atient& ha2e 2er *ood re&ult& with the&erocedure&. 7t i& criticall imortant to e*in h&ical thera immediatel after&ur*er to maintain the motion that wa& achie2ed intraoerati2el.

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Fiure .a.hi& woman wa& unale to rai&e her ri*ht arm due to adhe&i2e ca&uliti&. After man month& of worin* with a h&icaltherai&t and tain* anti-inflammator medication&! &he &till ha& a oor ran*e of motion. *.A *eneral ane&thetic i& admini&tered andatient i& a&lee. he arm i& then *entl taen throu*h a ran*e of motion! which rea& u the adhe&ion& and loo&en& the &houlderWith maniulation &he i& ale to achie2e full forward fle3ion. c.he &houlder i& maniulated in another lane 8cro&&-od adduction

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