Some of the most frustrated patients I see in my shoulder practice are those with what we call idiopathic frozen shoulder. This is a condition where patients between the ages of 45-55 begin to experience pain in the shoulder joint. A typical scenario is that if the symptoms are severe enough, they will have begun a course of physical therapy recommended by their primary care physician, with little or no response to this treatment. An MRI will have been obtained to look for tendon injury or other joint problems. Quite often these results are normal. So here you sit in the physician’s office with this painful and stiff joint, when according to the MRI, “there is nothing wrong”?!
Frozen shoulder is different from other shoulder conditions in that there usually is no injury involved, or if there is, it is minor. It begins with painful motion, typically with activities above shoulder level. As time progresses, so does the pain. Individuals commonly complain of pain with rest, pain with any motions, and pain that disturbs their sleep. This is accompanied by a gradual or sometimes dramatic loss of motion. Common functional complaints are the inability to reach behind the back, comb their hair, or apply deodorant to the opposite shoulder. No medications relieve this pain. Physical therapy doesn’t prevent the loss of motion. This painful period is termed THE FREEZING PHASE.
The next phase is THE FROZEN PHASE. This phase is identified when the pain changes. The rest pain goes away. There is still pain when the shoulder is placed in areas where it doesn’t wish to be, but overall the patient is more comfortable. However they are still quite frustrated by the lack of mobility.
THE THAWING PHASE is marked by a gradual increase in range of motion with increasing function. The pain slowly disappears and the night pain lessens. In 70% of frozen shoulder cases, the shoulder will move through these phases and eventually return to normal/almost normal. That’s the good news! The bad news is that each of these phases takes 4-8 months.
If this problem is detected in the early stages prior to significant motion loss, often an injection of the shoulder joint with an anti-inflammatory (corticosteroid) can short-circuit the process and avoid the evolution of the problem. When shoulder motion is restricted, however, letting the process run its course or surgery are options that can be discussed.
Surgery for this type of problem is arthroscopic. As with any surgical procedure there are risks and benefits that you should discuss with your orthopedist. The rehabilitation following surgery is intense and frequent to avoid a recurrence of the loss of motion.
Not every stiff shoulder is a frozen shoulder, so frequently diagnostic imaging is used to rule out other causes of motion loss. Frozen shoulder syndrome is frequently associated with diabetes mellitus, thyroid disease, and less frequently with early Parkinson’s syndrome; having a frozen shoulder doesn’t mean that you have any of these disorders, however.
Patience is the key. Frozen Shoulder has what we call a self-limited process, which means that eventually it will go away. But we all know that this is easier said than done!
Below are some resources where you can learn more about Frozen Shoulder if you have been diagnosed with Frozen Shoulder:
American Academy of Orthopaedic (Orthopedic) Surgeons – http://orthoinfo.aaos.org/topic.cfm?topic=A00071
Mayo Clinic – http://www.mayoclinic.com/health/frozen-shoulder/DS00416
Claude Nichols, M.D., an orthopedic surgeon, is Chair of Orthopedics and Rehabilitation at the UVM Medical Center, and Professor and Chair of the Department of Orthopedics and Rehabilitation at the Larner College of Medicine at UVM. His areas of expertise include knee care, shoulder care, and sports medicine.