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Frozen Shoulder (Adhesive Capsulitis)

Frozen shoulder, also known as shoulder contracture or adhesive capsulitis, is a condition where the synovial membrane – a soft tissue that forms a protective capsule around the shoulder joint – swells, thickens and contracts. Scar tissue forms, leaving less room for the upper arm to move around. This causes pain and restricts movement in the shoulder. The cause of this condition is unknown, but it often occurs in people who have other inflammatory disorders. Other people develop frozen shoulder after an injury or period of immobilization, such as after surgery.

Risk factors for frozen shoulder

Women are more likely than men to develop adhesive capsulitis, and most patients are roughly between ages 40 and 65. People who have thyroid disease, diabetes, an autoimmune disease, and/or injury, stroke, heart attack, or prolonged immobilization are also at higher risk. Occasionally, however, younger men and women without any of these risk factors will develop frozen shoulder.

Symptoms of frozen shoulder

Usually only one shoulder is affected, but about one-third of patients experience symptoms in both. Early symptoms include:

  • Pain in the shoulder, especially unexpected pain, when no known injury is present.
  • Difficulty lifting one’s arm above the head.
  • Difficulty extending one’s arm across the body or reaching behind the back.

If you experience these symptoms, see a doctor immediately. Untreated, the condition will worsen and can last two years or longer. Symptoms usually appear in four stages over about 24 months:

Stage 1, months 1-3: Shoulder pain causes you to limit your arm movement.

Stage 2, months 3-9: The “freezing” stage, where pain continues (although it may lessen) but you experience decreased ability to move your shoulder properly.

Stage 3, months 9-14: The “frozen” stage, where the shoulder is stiff but no longer hurts when you are not moving it.

Stage 4, months 15-24: The “thawing” stage, where your ability to move your shoulder gradually returns.

Treatments for frozen shoulder

Non-surgical treatment is the best first option. Usually, this is a mix of physical therapy (PT) and medication. PT will involve significant stretching to prevent loss of motion. Your doctor may also prescribe oral anti-inflammatories, pain medication, corticosteroid injections, or some combination of these remedies.

If these treatments are not enough, two surgical options are available:

  • Manipulation under anesthesia: Also known as closed manipulation, this is a non-invasive procedure. The patient is put under general anesthesia and the surgeon moves the affected shoulder through its full range of motion. This breaks up the scar tissue to improve shoulder mobility.
  • Arthroscopic capsular release: Usually performed on patients who are in the second or third stage of adhesive capsulitis, this form of shoulder arthroscopy surgically releases the scar tissue. This is sometimes followed by manipulation under anesthesia.

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