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Frozen Shoulder

Alternate Names

  • adhesive capsulitis

Definition

Frozen shoulder is a disorder characterized by pain and loss of motion in the shoulder. It affects about 2% of the general population. It is most common in women between the ages of 40 to 70 years old. The causes of frozen shoulder are not fully understood.

What is going on in the body?

The process involves thickening and contracture of the capsule surrounding the shoulder joint. Adhesions, or abnormal bands of tissue, grow between the bones of the shoulder joint and severely limit movement. In addition, the normal synovial fluid found in the shoulder joint begins to disappear, causing further pain and restricted motion.

Risks

What are the causes and risks of the condition?

This condition can occur after an injury to the shoulder, chest, or head. Any injury that prevents normal shoulder or arm movement may result in a frozen shoulder. Other risks for frozen shoulder include:
  • heart attack
  • chest surgery, such as open heart surgery
  • breast surgery, such as a modified mastectomy for breast cancer
  • brain surgery, which may follow head injury
  • Type I diabetes
  • hypothyroidism
  • Parkinson's disease
Frozen shoulder is most common in middle-aged women or people who have depression.

Prevention

What can be done to prevent the condition?

In most cases, frozen shoulder can be avoided with prompt treatment of shoulder injuries and active use of the shoulder. Physical therapy can be useful in promoting proper use of the joint.

Diagnosed

How is the condition diagnosed?

The diagnosis is usually based on a physical exam, which reveals limited shoulder motion that cannot be explained by an injury or disease. Tests of the shoulder joint may include:
  • joint x-ray, with or without the injection of contrast media
  • magnetic resonance imaging (MRI)

Long Term Effects

What are the long-term effects of the condition?

A possible long-term effect is chronic shoulder stiffness resulting in loss of strength and permanent disability.

Other Risks

What are the risks to others?

There are no risks to others as this condition is not contagious.

Treatments

What are the treatments for the condition?

Stretching exercises are often prescribed to loosen the joint. The healthcare professional may inject the shoulder with cortisone or a long acting anesthetic. This can decrease some of the pain and allow the patient to stretch the shoulder more effectively.
Medications such as non-steroidal anti-inflammatory drugs (NSAIDS) can decrease inflammation and pain. Physical therapy can be helpful to increase the range of motion in the joint. Manipulation of the shoulder under anesthesia, also known as arthroscopic capsular release, may be required if exercises and medications are unsuccessful.

Side Effects

What are the side effects of the treatments?

Rarely, shoulder manipulation can cause a torn ligament or tendon, or even a shoulder fracture. Allergic reactions may occur with injection of cortisone or an anesthetic.

After Treatment

What happens after treatment for the condition?

Individuals are encouraged to maintain range of motion by doing daily exercises.

Monitor

How is the condition monitored?

The healthcare professional will check shoulder range of motion during regular follow-up visits until the problem has resolved.

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