Frozen Shoulder, or what we call adhesive capsulitis, is a very interesting condition of the shoulder.
There has been a lot of research into what is actually happening. That is why it is a very perplexing condition because there are a lot of different theories.
The main one that kind of stays is it is almost a contracture of the shoulder capsule itself, meaning that the shoulder capsule itself becomes contracted down and actually tightens.
There are several different reasons for why we think that this happens. Some people think that it is due to an injury to the actual capsule or the tissue that makes up the deep joints between the shoulder bones or the humerus and the glenoid.
Some people think it is an injury that causes it. Other people think it is an underlying condition like diabetes, another condition that you get in the hands called dupuytren’s contracture.
Some people say, ‘You know what? It might not be any of those reasons. We don’t really understand why some people get it.’
People will come in and they will present with symptoms of pain in the shoulder. Just about everybody who has adhesive capsulitis or Frozen Shoulder has pain but, the hallmark of it is very, very decreased range of motion. It is severely restricted and that is what really points towards that capsule being contracted.
We do know that it tends to follow a pretty set path. There is a freezing, a frozen and a thawing stage. During the freezing stage there is more and more pain and you are losing your range of motion. During the frozen stage there tends to still be pain but the hallmark there is it is kind of stuck or it is a Frozen Shoulder, adhesive capsulitis. During that thawing stage that is where things seem to loosen up - the pain starts to relieve, the range of motion gets better. The most perplexing and interesting thing about this condition is, for the majority of people we can almost always tell them that over time this is going to get better.
As soon as that capsule gets tight and the patient loses that range of motion in the arm the tendons and muscles over the top of those tend to also get tight. You can have a lot of secondary problems - you can have irritation of nerves around the shoulder, you can have tendonitis around the shoulder, you can develop elbow and neck and wrist pain, all because this shoulder won’t move.
On average, which is a wide average, but I would say is about six months to two years.
There is no really defining features or anything that the patient presents with that can give us an idea for how long that is going to take.
It can and it is not very predictable. There are some people who will develop it in one shoulder and later on in life develop it in the other shoulder. There are some people who only get it in one shoulder, get it once and it's gone.
Then there are other people who they get it once and they continue to get it in the same shoulder.
We know that physical therapy has a role in trying to minimize that lack of range of motion.
When therapy is something that is not working, there are different injection techniques that can be done.
So a cortisone steroid injection can be considered, especially during that freezing phase, while it is so inflamed to try and decrease that inflammation and pain. There is also a procedure that is called a hydrocodone where you use fluid to almost stretch the capsule from the inside. It is essentially sterile water and an anesthetic that is injected.
For some patients we do resort to surgery. The first step would be what we call manipulation under anesthesia, which is where a patient is sedated and their shoulder is taken through a range of motion to open up all of the adhesions.
Then the last step would be surgery. They would go in and actually remove part of the capsule or try and decompress where all the adhesions are.
So, there are a lot of different options for this condition because it doesn’t’ respond to just one specific thing. The treatments don’t reproducibly have the same result and that in turn is what makes it such a perplexing condition.
One of the things that we tell people is that when they injure their elbow or their shoulder, if they aren't able to move their shoulder because there is so much pain or they don’t have the strength they need to be evaluated very quickly about that to see if there is a rotator cuff tear or if there is fracture in the shoulder.
The one thing that we could probably decrease the rate of people developing Frozen Shoulder after injury is how long we immobilize the shoulder in a sling.
So the best advice I can give if for an injury that is not a fracture or a full rotator cuff tear that has already been diagnosed by a physician is don’t stay in a sling too long.
It is important for patients to know that out of all of the conditions that we take care of, this is one of the most difficult. It is difficult not only because of the pain and the lack of range of motion but it is difficult because of the way it affects patient’s lives.
When you don’t have the use of your shoulder like you had before, you become very dependent on other people to do simple things just like feeding yourself and sometimes dressing yourself or being able to bathe yourself. You don’t have that autonomy that you once had and so this condition can actually be very depressing. It can affect yourself and your family.
That is very normal and that is why you need a good team to take care of this when you have it. Just being able to say you need to go to physical therapy normally isn’t enough. You need to have a team that is not only focusing on your shoulder but is also focusing on you and your family and your entire life because this is a condition that affects all of those and that is what we at the Cleveland Clinic do is we don’t take care of just the problem we take care of the whole patient.