A frozen shoulder is a painful and stiff shoulder which over time might become very difficult to move. Frozen shoulders occur in about 5 percent of the population and most often affect people between the ages of 40 and 60. It is more frequent in women, and most cases occur without a known cause.
In a frozen shoulder, the shoulder capsule thickens and becomes tight. The hallmark sign of this condition is being unable to move your shoulder. The condition develops in three stages: First, in the “freezing” stage, pain slowly increases. As the pain worsens, the shoulder loses motion. The freezing lasts from six weeks to nine months.
The second stage is the “frozen” component. Painful symptoms might improve during this stage, but the stiffness remains. During the four to six months of the “frozen” stage, daily activities might be difficult.
Third is the “thawing” stage. Shoulder motion slowly improves, and complete return-to-normal strength and motion typically takes from six months to two years.
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The causes of frozen shoulder are not fully understood. Frozen shoulders occur much more often in people with diabetes. Additional medical problems associated with frozen shoulder include hypothyroidism, hyperthyroidism, Parkinson’s disease and cardiac disease. Also, a frozen shoulder can develop after a shoulder has been immobilized due to surgery, a fracture or other injury.
If someone thinks they might have a frozen shoulder they should see their physician. After taking a medical history, the doctor will examine the shoulder. Imaging tests might rule out other causes of stiffness and pain. These include X-rays, magnetic resonance imaging (MRI) and ultrasounds.
More than 90 percent of patients improve with nonsurgical treatments. Non-steroidal anti-inflammatory medicines and steroid injections may reduce pain and swelling. Physical therapy will help restore motion.
If symptoms are not relieved by therapy and medicines, surgery might be indicated. The goal of surgery is to stretch and release the stiffened joint capsule. The most common methods include manipulation under anesthesia and shoulder arthroscopy.
After surgery, physical therapy will be necessary and recovery might vary weeks to months. The long-term outcomes are generally good, with most patients having reduced pain and improved range of motion. Although uncommon, a frozen shoulder can recur, if a contributing factor such as diabetes is still present.
Dr. Timothy C. Wilson, an orthopedic surgeon with Baptist Health Medical Group Orthopedic Surgery, practices at Baptist Health Lexington.