'Unfreezing' a Frozen Shoulder

Frozen shoulder is a painful condition which should be promptly treated.

Shoulder Joint
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More than 150 years ago, a description of frozen shoulder first appeared in the medical literature. Despite long-time awareness of this painful condition, however, we still don't completely understand its pathology and, in many cases, have no idea what causes it.

What Is Frozen Shoulder?

Frozen shoulder or adhesive capsulitis is a condition that limits the range of motion of the shoulder. The shoulder—like the knee, elbow, and hip—is a joint.

The shoulder joint (glenohumeral joint) is made up of a capsule filled with ligaments which attach the shoulder bones together. When this joint becomes inflamed, as happens with frozen shoulder, it becomes darn painful to move your shoulder.

Results from biopsy suggest that frozen shoulder begins as a chronic inflammatory condition followed by fibrosis and fibroblast proliferation. This proliferation is likely immunomodulated. On a related note, the pathology of frozen shoulder is likely similar to Dupuytren's contracture, another fibrotic condition which affects the fingers.

Frozen shoulder is usually diagnosed by a physician after a physical exam. Often, diagnostic imaging modalities like x-ray provide little confirmation of this diagnosis although MRI and ultrasound can show soft tissue changes like ligament thickening.

Frozen shoulder affects between 2 percent and 5 percent of all people.

Although in most people, the condition eventually remits, this debilitating and painful condition is the bane of primary care physicians and specialists because it's notoriously difficult to treat.

Risk Factors for Frozen Shoulder

In most people, frozen shoulder is idiopathic. (Idiopathic is medical jargonese referring to unknown cause).

Nevertheless, certain risk factors likely play a role in this condition including the following:

  • shoulder injury
  • shoulder surgery
  • diabetes
  • cervical disease of the neck
  • thyroid problems
  • open heart surgery

Differential Diagnosis for Frozen Shoulder

Because the diagnosis of frozen shoulder primarily relies on clinical exam findings, differential diagnoses or other shoulder pathology must be considered. Here is a list of diseases that present like frozen shoulder:

Treatment for Frozen Shoulder

With respect to treatment, it's important to first diagnose and treat any underlying risk factors for frozen shoulders like diabetes and thyroid disease.

Because the frozen shoulder is painful, pain management with drugs like NSAIDs or steroids are a good idea. Of note, steroids provide short-term pain relief of frozen shoulder and can either be injected into the shoulder joint or taken by mouth.

When all other treatment fails, manipulation of the shoulder joint under anesthesia or arthroscopic surgery or open capsular release are last options. After surgery, it's imperative that you participate in physical rehabilitation in order to keep the frozen shoulder from recurring.

Even left untreated, frozen shoulder usually goes away in time and sometimes pain can decrease in just a couple of days. Ultimately, in 90 percent of all people, the disease remits. However, treatment can hasten healing. Please keep in mind that if left untreated, sometimes frozen shoulder can last up to 3 years.

If you or someone you love suffers from what appears to be a frozen shoulder, please see a physician immediately. There's no reason to suffer especially when a treatment exists.  \Of note, early treatment can prevent future stiffness. Moreover, your primary care physician may need to refer you to a rheumatologist or orthopedic surgeon. Please remember that your physician is there to help you and answer your questions; it's always a good idea to make an appointment with your physician whenever you have any health concerns. Finally, if you have diabetes or thyroid disease, it's a good idea to keep these conditions under control not only to prevent frozen shoulder but also to remain healthy.

Selected Sources

Article titled "The Pathology of Frozen Shoulder" by GCR Hand and co-authors published in the Journal of Bone and Joint Surgery in 2007.  Accessed on 7/19/2015.

Article titled "Adhesive Capsulitis of Shoulder" from Ferri's Clinical Advisor 2016 by FF Ferri.  Accessed on 7/19/2015.

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