Frozen ShoulderWritten by Eric Mullins, M.D.06/23/2009
News Article
The term “frozen shoulder” is one that is loosely applied to many problems that occur about the shoulder. For physicians, it is not a diagnosis, but rather a description of a group of symptoms: poor shoulder range of motion, poor shoulder function and pain, that could be the result of a variety of causes. The pain and stiffness could be due to disuse, overuse or not using the extremity in a normal fashion. It could be due to traumatic causes from falls, arthritis, or a complication of stiffness after a shoulder operation. “Frozen Shoulder” also describes a true disease process – adhesive capsulitis.
The shoulder is an interesting joint. It must allow both full range of motion as well as provide stability. The muscles that surround the shoulder joint and the capsule, which holds the ligaments that help support the shoulder joint, are vital. The muscles around the shoulder can be loosely classified into two categories. The smaller muscles that directly surround the shoulder joint include the four muscles of the rotator cuff. These rotator cuff muscles function to load the shoulder joint when they contract and provide stability to the shoulder while the larger muscles place the arm in space with power. The capsule and ligaments about the shoulder act as check reins, or the reins one uses to guide a horse while riding it. These ligaments provide stability only at the extremes of motion such as
when the arm is fully extended and brought overhead, like when you throw a ball overhand. When the capsule and ligaments have become tight and prevent the arm from engaging in the full range of motion, this is what is loosely termed as having a “frozen shoulder.”
Your physician will take a detailed history of the symptoms and their onset, gaining clues to determine the underlying process involved. This is key to defining a specific treatment
plan to best help you regain pain free shoulder function. And it helps the physician better understand some of the underlying causes that need to be treated within the treatment plan.
Treatment options will range depending on the underlying cause. Physical therapy may be prescribed for range of motion and strengthening of specific muscles. Pain control measures may be recommended such as steroid injections to reduce inflammation around the shoulder joint. Operative intervention may be needed to repair torn structures or for true adhesive capsulitis.
Adhesive capsulitis is a disease in which the normal shoulder capsule is infiltrated with a specialized type of cell called a myofibroblast. These myofibroblasts latch onto one another and contract, limiting shoulder range of motion. The disease actually progresses through three stages over the course of 12-18 months. In the first stage, the patient’s shoulder becomes progressively morestiff over 4-6 months, losing motion and function. Treatment at this stage is predicated on pain control and attempted gains of motion with physical therapy. The second stage, which may last 6-12 months, is characterized by a diminishing level of pain in an otherwise very stiff, limited shoulder. The shoulder “thaws” in the third stage, lasting approximately 4 to 6 months. Pain diminishes and there is a spontaneous increase in shoulder range of motion. Treatment during the second and third stage may include operative intervention such as arthroscopic joint debridement, release of tight structures and shoulder manipulation to improve long term shoulder function and decrease the length of time the shoulder is limited. While adhesive capsulitis can be treated nonoperatively, the resulting range of motion in the affected shoulder is typically less than that of the patient’s other shoulder and less than that of people who have not experienced the disease. A candid discussion with your physician regarding treatment outcomes and quality of life is recommended so that you can make the decision that is best for you.
Contact Information
Leah Hollenberger
Senior Director Development, Marketing & Public Relations
Copley Hospital
802-888-8301
lhollenberger@chsi.org
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