What is frozen shoulder and can it be permanent? Explore the causes, diagnosis, and effective treatments for this condition. Get detailed insights and answers to common questions.

Understanding Frozen Shoulder

Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by the gradual loss of movement in the shoulder (glenohumeral) joint. This joint, which consists of a ball (the humeral head) and a socket (the glenoid), normally allows for a wide range of motion. However, in a frozen shoulder, the joint has become “stuck” and its movement is severely limited.

Causes of Frozen Shoulder

Although the exact cause of frozen shoulder is not fully understood, it is most often attributed to inflammation and scarring of the tissues surrounding the shoulder joint, known as the capsule. The capsule normally has folds that can expand and contract as the arm moves into different positions. In a frozen shoulder, the capsule becomes inflamed and scarring, known as adhesions, develops. As the capsule’s folds become scarred and tightened, shoulder movement becomes restricted and moving the joint becomes painful.

Factors that may contribute to the development of frozen shoulder include immobilization of the shoulder (after an injury or surgery), as well as inflammation of the muscles and/or tendons, such as in cases of rotator cuff tendinitis or bursitis.

Diagnosing Frozen Shoulder

The diagnosis of frozen shoulder typically begins with a comprehensive history and physical examination by a healthcare provider. They may order additional tests, such as X-rays, to rule out other potential causes of shoulder pain and limited mobility, such as arthritis or calcium deposits.

Can frozen shoulder be permanent?

No, frozen shoulder is generally not considered a permanent condition. With proper treatment and rehabilitation, the majority of patients with frozen shoulder are able to regain full or near-full range of motion in the affected shoulder.

Treating Frozen Shoulder

The primary goals of treatment for frozen shoulder are to increase range of motion and decrease pain. The most common approach involves a combination of physical therapy and anti-inflammatory medication.

Physical Therapy

Physical therapy is usually the first line of treatment for frozen shoulder. A physical therapist will prescribe exercises and techniques to stretch the shoulder capsule and improve mobility. These may include the use of a wand, overhead pulleys, elastic cords, and other tools to gently stretch and mobilize the shoulder. The patient is also typically instructed to perform these exercises at home on a regular basis.

Medication

Anti-inflammatory medications, such as aspirin, ibuprofen (Motrin, Advil), naproxen (Naprosyn), or Aleve, are often recommended to help reduce pain and inflammation. In some cases, the healthcare provider may also prescribe pain medications or steroid injections to the shoulder joint or surrounding bursa to further manage symptoms.

Recovery Timeline

The recovery process for frozen shoulder can vary, but it typically takes between 6 to 9 months for the condition to resolve almost completely. Supervised physical therapy may last from 1 to 6 weeks, with visits ranging from 1 to 3 times per week. Patients are encouraged to continue the prescribed stretching exercises at home throughout the healing process.

When is surgery indicated?

In most cases, the combination of physical therapy and medication is sufficient to improve range of motion and decrease pain. However, if non-operative treatments fail to provide significant improvement, surgery may be considered. During the surgical procedure, the physician may manipulate the shoulder under anesthesia to break down the scarring or use an arthroscope to release the tight capsule.

Preventing Frozen Shoulder

While there is no guaranteed way to prevent frozen shoulder, maintaining good shoulder mobility and strength through regular exercise and physical activity can help reduce the risk of developing this condition, especially after an injury or surgery that requires immobilization of the shoulder.

Key Takeaways

• Frozen shoulder is a condition characterized by the gradual loss of shoulder movement, typically due to inflammation and scarring of the shoulder capsule.
• Frozen shoulder is not a permanent condition, and the majority of patients are able to regain full or near-full range of motion with proper treatment.
• The primary treatment for frozen shoulder involves a combination of physical therapy and anti-inflammatory medication, with the goal of increasing range of motion and decreasing pain.
• Recovery from frozen shoulder can take several months, but regular stretching and exercise can help improve outcomes.
• In cases where non-operative treatments fail to provide significant improvement, surgery may be considered as a last resort.

Frozen Shoulder | Johns Hopkins Medicine

What You Need to Know

Frozen Shoulder

• A frozen shoulder is one that has become stuck and limited in movement.
• Frozen shoulder is often caused by inflammation of the capsule, tissue
  surrounding the shoulder joint.
• Diagnosing frozen shoulder requires a physical examination and possible

  X-rays

  or additional tests to rule out other causes of symptoms.

• Physical therapy and anti-inflammatory medication are usually
  prescribed to treat frozen shoulder.
• Surgery is not usually indicated to treat frozen shoulder unless
  non-operative treatments have failed to improve range of motion and
  decrease pain.

What is frozen shoulder?

Frozen shoulder results from the gradual loss of movement in the shoulder (glenohumeral) joint. This joint consists of a ball (the humeral head) and socket (the glenoid). Normally it is one of the most mobile joints in the body. When the shoulder is frozen, the joint has become stuck and its movement is limited.

What causes frozen shoulder?

Although many shoulder diseases involve pain and loss of motion, frozen shoulder is most often caused by inflammation (swelling, pain and irritation) of the tissues surrounding the joint. The tissue that envelops the joint and holds it together is called the capsule. Normally the capsule has folds that can expand and contract as the arm moves into various positions. In a frozen shoulder, the capsule has become inflamed and scarring develops. The scar formations are called adhesions. As the capsule’s folds become scarred and tightened, shoulder movement becomes restricted and moving the joint becomes painful. This condition is called adhesive (scarring) capsulitis (inflammation of the capsule).

It is not known exactly what causes this condition. Immobilization of the shoulder (after an arm injury, for instance) can lead to frozen shoulder. Inflammation of the muscles and/or tendons, as with rotator cuff tendinitis or bursitis, can also cause the shoulder joint to become frozen.

How is frozen shoulder diagnosed?

The first step is to have a complete history and physical examination by your physician. Your physician may order several tests, such as X-rays, to rule out other potential causes of a painful shoulder or limited shoulder motion (arthritis, calcium deposits, etc.).

How is frozen shoulder treated?

The two main goals of treatment are to increase motion and to decrease pain. To increase motion, physical therapy is usually prescribed. The physical therapist moves the patient’s arm to stretch the capsule and teaches the patient home exercises that may include use of a wand or overhead pulley. He or she may also use ice, heat, ultrasound or electrical stimulation. The therapist will demonstrate a stretching program that you should do at least once or twice a day. These exercises include the use of a cane, a home pulley system and an elastic cord to increase motion of the shoulder.

To decrease pain, physicians frequently recommend anti-inflammatory medications such as aspirin, ibuprofen (Motrin, Advil), Naprosyn or Aleve. Pain pills such as Tylenol or narcotics may be prescribed to decrease the pain after therapy or to help with sleep at night. Occasionally, steroid injections of the joint or the bursa may be indicated. Steroids like prednisone, taken by mouth, may be given to help decrease the inflammation.

How long does rehabilitation take?

Supervised physical therapy usually lasts from one to six weeks, with the frequency of visits ranging from one to three times per week. The patient should engage in home exercises and stretching throughout the healing process. The stretching exercises should be done at home at least once or twice daily, as noted above. In general, frozen shoulder will resolve almost completely with time and consistent compliance with the prescribed treatment program. This process can take up to six to nine months for some patients, although it may take only a few months for others. Internal rotation (moving the hand to the back pocket or up the middle of your back) is usually the motion that takes the longest to regain.

When is surgery indicated?

If the above program does not improve the range of motion and decrease the pain, then surgery may be indicated. After the patient has had a general or regional anesthetic, the physician may manipulate the shoulder in the operating room to break down the scarring. Occasionally, an arthroscope (a small instrument with an attached camera placed into the shoulder through a small puncture-type incision) is used to directly cut or release the capsular adhesions. Most patients begin physical therapy the same day of the manipulation or the following day.

Other operations, such as the removal of spurs, may also be indicated or required at the time of the manipulation. These operations can sometimes be done with the arthroscope, but may require one or two larger incisions around the shoulder (open surgery).

Healing Shoulder Pain: A troubleshooting guide for common shoulder problems

Raise your hand if you’ve never had shoulder pain.   Indeed, shoulder pain can make even that simple act agonizing.                                                                                                           

Shoulder problems not only keep you from doing the things you enjoy but make even routine daily activities daunting and difficult.

You can find freedom and relief from shoulder pain!

The fact is, more than 70% of people will suffer the effects of shoulder pain.  You don’t have to be one of them!

In this report you’ll find how you can reduce and relieve shoulder pain…the best techniques to reverse and repair damage…and tips to strengthen and protect your shoulder’s mobility and durability.

You can’t just shrug off shoulder pain.                                                                       

Shoulder problems rarely go away on their own.   Healing Shoulder Pain will show you how to speed their departure with targeted diagnoses and tailored treatments.

You’ll discover how to accurately pinpoint the condition triggering your pain and how to effectively and safely achieve lasting pain relief and maintain flexibility and renewed range-of-motion.

You don’t have to wince—or wonder.

From the doctors of Harvard Medical School, the Report will take you from symptoms to source to solution.  You’ll learn the telltale symptoms that distinguish tendinitis from bursitis…what condition a “Popeye muscle” bulge may signal…and the sometimes unrecognized signs of a rotator cuff tear.

You’ll find the ideal imaging test to diagnose shoulder problems…why you may be increasingly vulnerable to shoulder impingement…and a condition whose symptoms women especially need to watch for.

The bottom line on the best first line treatments!

Healing Shoulder Pain will show you how to initiate pain relief and improve mobility with the least invasive procedures.   You’ll discover a proven approach to end the pain of a separated shoulder…a gentle technique to thaw a frozen shoulder…the most effective OTC medications for shoulder arthritis…a complete shoulder workout to strengthen shoulder muscles…and much more.

You’ll be in the forefront of today’s advances in shoulder surgery.

You’ll learn the important considerations when choosing a surgical procedure…what to expect before, during, and after surgery…and the breakthroughs that are lessening pain and speeding recovery.

You’ll be briefed on an outpatient procedure to relieve chronic arthritis pain…the one gold standard surgery for long-term pain relief…an arthroscopic technique to stabilize a joint after repeated dis-locations and two new technologies that are making shoulder surgery easier and safer than ever. 

Wave good-bye to shoulder pain!  Don’t wait!   Send for your copy of Healing Shoulder Pain today.  

Prepared by Harvard Health Publishing in consultation with Jon J. P. Warner, MD, Chief, Shoulder Service, Massachusetts General Hospital Professor of Orthopedic Surgery, Harvard Medical School Director, Boston Shoulder Institute. (2022)

A number of factors increase your likelihood of developing shoulder pain, including age, gender, and genes. Even being overweight or smoking can play a role. Some of these factors fall within your control, while others are beyond it.

Genes: Certain shoulder problems seem to run in families. Rotator cuff injuries are more likely to occur not only in siblings, but also in cousins and other more distant relatives. The tendency to injury may be due at least in part to inherited anatomical differences in the shoulder joint. It’s also possible that family members tend to share shoulder-straining experiences—for example, if they play the same sports or have the same physically demanding occupation.

Arthritis also has a genetic component. Inherited characteristics in the shape of the acromion (a bony projection on the end of the shoulder blade) and the glenoid cavity (the socket in the shoulder joint) can increase the likelihood of shoulder degeneration and damage.

Age: Your likelihood of developing osteoarthritis increases as you age. Years of playing tennis and golf or engaging in other repetitive activities can cause minor injuries that add up over time, eventually leading to a loss of the cartilage that cushions your shoulder joints. Osteoarthritis and soft tissue conditions, such as rotator cuff injury, shoulder impingement syndrome, and frozen shoulder, are the most common causes of shoulder pain in older adults.

Gender: Women are at higher risk for shoulder pain than men. Their smaller size, coupled with generally weaker muscles, leads to greater shoulder instability. In addition, after a woman spends years playing sports or engaging in repetitive motions at work, her shoulder joints begin to loosen, putting her at increased risk for dislocation. Hormones might play a role in gender-related shoulder differences. Relaxin, the hormone released during pregnancy to ease delivery, does so by relaxing ligaments throughout the body. For these reasons, women are more likely to suffer injuries when they play sports. However, because men participate in sports more over all, they account for a greater proportion of sportsrelated shoulder injuries.

Obesity: Extra weight puts added pressure on the joints, and the heavier you are, the more weight your joints have to bear. The knees and hips carry most of this force, but shoulders can be affected, too. Obesity might also contribute to shoulder pain by triggering the release of inflammatory substances. Inflammation activates pain receptors in the area, contributing to shoulder pain.

Other medical conditions: People with certain medical disorders are more likely to develop shoulder pain. These disorders include diabetes, multiple sclerosis, fibromyalgia, and inflammatory forms of arthritis, such as such as rheumatoid arthritis and psoriatic arthritis.

In diabetes, chronic high blood sugar leads to connective tissue damage and inflammation in the shoulders, as well as in other parts of the body. Frozen shoulder and rotator cuff injuries are particularly common in people with diabetes. Although researchers don’t know exactly why, it may have to do with impaired blood flow. Another possible culprit is the formation of damaging substances known as advanced glycation end products. These substances—which form when blood sugar is high, and sugar molecules attach abnormally to protein or fat—can make tendons stiff and weak.

Multiple sclerosis causes nerve damage, which leads to pain, weakness, and reduced function throughout the body, including the shoulders. Fibromyalgia is marked by muscle pain and tenderness at various sites, including the neck and shoulders. And inflammatory forms of arthritis produce inflammation in the joints.

Smoking: Along with the many other ill effects of cigarette smoking— among them cancer, heart disease, and lung disease— some studies have linked this harmful habit to shoulder pain, tendon injury, and an increased risk for rotator cuff tears. Smoking promotes inflammation, and it robs the blood of the oxygen needed to heal injuries in the shoulders and elsewhere in the body.

People who smoke tend to have larger rotator cuff tears, and they don’t improve as much after rotator cuff surgery as nonsmokers, according to a 2018 study in BMJ Open Sport & Exercise Medicine. Another study found that smokers didn’t heal well after rotator cuff repair. Nicotine—the active component in tobacco smoke—reduces blood flow to the rotator cuff, an area of the body that already has a limited blood supply. A steady flow of oxygen- and nutrient-rich blood is essential for maintaining a healthy rotator cuff, as well for promoting healing after surgery.

causes, symptoms, diagnosis and treatment at KONSTANTA Clinic in Yaroslavl

Content:

1. The essence of the disease and its causes
2. Symptoms of inflammation of the capsule of the shoulder joint
3. Forms of capsulitis and stages of development
4. Diagnostics
5. Treatment
6. Rehabilitation
7. Preventive measures

The most important joint of the upper part of the human skeleton is the shoulder joint. It is formed by the bones of the shoulder, scapula and collarbone, which are covered with a protective sheath filled with liquid. This joint capsule, consisting mainly of ligaments, provides stability to the bones and prevents them from rubbing against each other. Its damage brings patients to the KONSTANTA Clinic in Yaroslavl with complaints of reduced mobility and severe pain in the shoulder. Capsulitis, which is also commonly called “frozen shoulder”, affects mainly middle-aged and older people (40-60 years), women more often than men.

The essence of the disease and its causes

The vernacular name of the disease speaks of the main sensation in the shoulder joint – freezing, that is, stiffness of the movements of the sore arm. Limitation of mobility of the shoulder joint occurs due to damage to the capsule, which is characterized by its compaction, inflammation of the lining cavity, thickening and stretching of the synovial membrane. These violations minimize the possibility of raising in the frontal direction and abduction of the arm, in severe cases, deliver significant pain with every action. The disease comes on suddenly and gradually progresses.

CAUSES CAUSING THE DISEASE
Mechanical injuries	Fresh bruises, fractures and even old injuries in this area are factors that directly affect the onset of the disease.
Uneven load on the spine and shoulder	Work that involves a long stay in immobility, in an uncomfortable position, with frequent lifting of the arms up, disrupts blood circulation in the tissues.
Violation of metabolic and metabolic processes in the body	Oncology, diabetes mellitus due to constant insulin intake, the changing hormonal background of a woman during menopause disrupt normal metabolism and metabolism.
Presence of concomitant diseases, including hereditary	The cause of capsulitis is often chronic pathologies of the blood circulation, respiratory, nervous, cardiovascular systems, periarthritis of another joint, osteochondrosis of the cervical spine.
FACTORS INCREASING THE RISK
Lack of physical activity	The lack of sufficient physical activity for the shoulder muscles can cause pathological processes in cartilage tissues.
Bad habits	The negative effects of alcohol and nicotine on the body can increase the likelihood of developing pathology.

Inflammation can be caused by a common viral infection, hypothermia, or a minor injury to the upper limb, with which medical attention is not always sought. If you experience the characteristic symptoms of a frozen shoulder, consult a doctor immediately! If it is untimely or incorrect to start treating capsulitis, it can lead to serious complications. With a running pathological process, you can lose the functionality of your hand for life and remain disabled.

Symptoms of inflammation of the capsule of the shoulder joint

There are two main manifestations characterizing the frozen state of the joint capsule:

1. reduced range of motion progressing to complete inability to move the affected arm;
2. pain in the joint when raising and turning the arm, which over time complements the pain syndrome in the neck and spine, numbness of the hand and awkwardness in the fingers, which increase as the pathology develops.

Depending on the cause and stage of the disease, the symptoms may vary slightly. If the ailment is not associated with previous injuries, the less active arm is usually affected. Discomfort and soreness at night are more intense than during the day. Without timely medical assistance, the patient experiences an increase in the symptoms of a “frozen shoulder”, which will be more difficult to get rid of than at the initial stage of the inflammatory process. To determine the degree of development of the pathology, a thorough medical examination is necessary.

Forms of capsulitis and stages of development

Inflammation of the ligamentous-tendon apparatus of the shoulder joint has two forms:
Post-traumatic	Idiopathic (adhesive)
It occurs as a result of a bone fracture, tendon rupture, other injuries or surgical interventions in the shoulder area, when the restriction of mobility is natural. The pathological process in this case develops as a result of insufficient or ineffective rehabilitation therapy.	The problem arises spontaneously, developing against the background of various pathologies of non-traumatic origin (diabetes mellitus, oncology, diseases of the nervous system, circulatory organs, heart attacks, strokes, heart surgery, inflammation of the articular and cartilaginous tissues). In this case, the joint capsule noticeably decreases in volume.

The disease, as practice shows, can last from several months to 3 years, passing through 3 stages of development:

1. Gradually lost mobility of the shoulder causes discomfort and mild pain mainly at night after motor activity of the arms and shoulder girdle. This phase can last from 1 to 9 months. Fixing the hand with an elastic bandage can improve well-being.
2. At this stage, the pathology is seriously progressing. It is difficult for the patient to move his hand without pain. The duration of the phase depends on the effectiveness of the treatment. It can lead to a transition to the recovery stage or delay the process for many years.
3. The last stage is characterized by increased symptoms. Soreness in the shoulder extends to the neck and spine. In the absence of treatment, limited movement comes to a complete loss of limb functionality.

Diagnosis

To take timely measures to eliminate the “frozen shoulder”, it is necessary to diagnose it as early as possible. The complex of differential diagnostics includes:

• drawing up a clinical picture based on a medical examination and patient complaints;
• arthrography to detect a decrease in the volume of the joint cavity;
• X-ray and ultrasound examination, in some cases – magnetic resonance or computed tomography;
• blood test for the presence of ESR protein in it.

Detection of pathology in the initial stage will cure it faster and more efficiently.

Treatment

The goal of therapy is to relieve patients of pain in the shoulder joint and restore the full functionality of the hand. Depending on the complexity of the case, this may take a month or several years. For a speedy recovery, the doctors of the KONSTANTA Clinic in Yarosalvl use complex treatment, which includes several reliable methods at once.

In the initial phase of the development of the pathological process, conservative methods for eliminating problems of the shoulder joint are quite enough. When contacting the Clinic in the first months of malaise, these techniques can help the patient. However, they will not have the desired effect when the condition is neglected, pathological scars and adhesions have formed in the tissues. In this case, surgical intervention is necessary to fully restore the functions of the affected hand.

In the presence of the “frozen shoulder” disease, patients of the CONSTANT Clinic most often choose arthroscopic surgery.

Rehabilitation

The advantage of arthroscopy is the shortest possible recovery period. Even in difficult cases, pain disappears after a few weeks, and full recovery occurs in 3-6 months. Additionally, rehabilitation after surgery is accelerated by the use of physiotherapy procedures and physical exercises with a gradually increasing load to restore the motor functions of the hand.

For a quick recovery without complications, it is also necessary to follow medical recommendations .

Preventive measures

Mobility-restricting capsulitis greatly reduces the quality of life. To prevent these problems, specialists at the KONSTANTA Clinic in Yaroslavl recommend avoiding injuries to the upper extremities, avoiding uneven distribution of the load on the back and shoulders. If you find the first signs of pain, difficulty in moving your hands, immediately seek qualified medical help in order to avoid complications in the future!

If you have any questions or sign up for a consultation with a specialist, please call:
(4852) 37-00-85
Daily from 8:00 to 20:00

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