The Frozen Shoulder

Selected Features of Our Program

Evaluation and Diagnosis

If a shoulder becomes stiff in several directions at once without suffering an injury this is called "frozen shoulder". Females are affected more than males, and typically between the ages of 40 and 60. The cause is not fully understood, although it is more common in patients with diabetes. The shoulder's lining becomes painful and inflamed, resulting in progressive loss of motion. This is the "freezing" phase. The amount of stiffness then stabilizes for a period of time. Finally, the "thawing phase" allows a slow return of motion over the course of many months. The diagnosis is made with a shoulder specialist using physical examination and imaging studies. Regular x-rays are taken to exclude other shoulder problems. Injection of contrast dye demonstrates the contracted lining and resultant loss of space in the joint. An MRI is ordered only when there is the possibility of additional damage to the "rotator cuff" tendons.

Treatment and Recovery

Frozen shoulder can be treated without surgery most of the time. The key to success is a comprehensive well-planned physical therapy program. Gentle manual stretches loosen the contracted joint lining. A cortisone injection decreases the inflammation during therapy. The exercises must be done regularly, and it may take several months to reach the maximum benefit. Some patients may not recover with therapy alone and may request surgery to advance their progress. Patients with diabetes have a special type of frozen shoulder that can be hard to treat with exercises alone. The surgery involves a complete evaluation of the joint with a small fiber-optic camera inserted through tiny holes. This arthroscopic evaluation is then followed by a release of tight tissues without making any other surgical incisions. The shoulder is gently taken through its full range of motion to confirm a successful release. Patients generally go home the same day. Exercises are started right away and must be continued on a daily basis. As motion improves, some gentle strengthening may be added to the therapy program. Ultimately, patients are usually able to return to their normal activities.