Frozen shoulder, or adhesive capsulitis, is a common condition usually affecting people over 40, and women more often than men. Statistics suggest that 5 percent to 20 percent of the population will experience an episode of frozen shoulder. Individuals with a history of diabetes, thyroid problems, Parkinson's disease or heart disease are at particular risk. Patients with frozen shoulder experience a progressive increase in pain and loss in range of motion.
To understand the condition, it helps to understand the shoulder's structure. The shoulder is a ball-and-socket joint, yet the shoulder's anatomy allows for an amazing amount of flexibility. The head of the humerus (upper arm bone) is a ball that sits in the glenoid fossa (shallow socket) of the shoulder blade. (Picture a golf ball on a tee.) Because the socket is so shallow, the shoulder relies on the surrounding soft tissues for stability. The labrum (cartilage lining the socket) and capsule (containing joint fluid and several ligaments) provide a majority of the shoulder's stability. The muscles of the rotator cuff and shoulder blade also help.
Our approach to frozen shoulder
A frozen shoulder typically heals on its own, although it's important to understand that full recovery can take a long time. A well-designed physical therapy program speeds the process, and some patients benefit from cortisone injections into the shoulder joint. Only a small percentage of patients need surgery.
Our team includes highly trained physical therapists and orthopedic surgeons with expertise in shoulder care. These specialists work together to relieve pain and restore mobility, so that patients can return to their normal lives and favorite activities.
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Signs & symptoms
Patients with frozen shoulder usually have increasing pain as their shoulder loses mobility. Quick shoulder motions often exacerbate the pain. Worsening stiffness can even make it difficult for other people, such as a doctor performing an exam, to move the shoulder. Frozen shoulder has been divided into three stages (note that the condition typically improves as it moves through the stages):
1) Freezing stage. There is a gradual increase in pain, sometimes brought on by an apparently minor injury. As the pain worsens, the shoulder loses range of motion.
2) Frozen stage. The pain improves, but the shoulder remains stiff.
3) Thawing stage. Shoulder mobility slowly returns to normal.
The freezing stage can last from one to nine months; the frozen stage, four to nine months; and the thawing stage, five months to two years.
A doctor can usually make the diagnosis by doing a physical exam, but sometimes imaging tests, such as X-rays or MRI, are useful for ruling out other problems.
Frozen shoulder will usually get better on its own, although it takes considerable time – sometimes two or three years. The goals of treatment are controlling pain and restoring motion.
The mainstay of frozen shoulder treatment is aggressive physical therapy. Techniques include stretching and range-of-motion exercises, followed by applying heat or ice to the area. As with any physical therapy regime, a good home program is essential.
Taken orally, nonsteroidal anti-inflammatory drugs (NSAIDs, such as naproxen and ibuprofen) can relieve pain, especially during the first ("freezing") stage.
A corticosteroid injection into the shoulder joint may foster a more rapid recovery, especially when done early in the disease process, as the shoulder is getting stiff. The procedure is performed in the office, often using ultrasound imaging to ensure the injection is placed accurately.
More than 90 percent of patients improve without surgery. For those who don’t get better with physical therapy and time, surgical intervention can be considered. In the arthroscopic (minimally invasive) procedure, the surgeon uses specialized instruments to view and release the tissue that has contracted around the shoulder joint and to break up any other adhesions (damaged tissues that have grown together). Patients can usually go home the same day, and physical therapy begins a few days later. Recovery varies from six weeks to four months.
UCSF Health medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.