Diseases & Conditions

Adhesive Capsulitis - Frozen Shoulder


Overview, Causes, & Risk Factors

Frozen shoulder usually occurs after a person injures the shoulder and does not move it for a period of time because of pain.

What is going on in the body?

When the shoulder is immobilized by pain, physical changes take place within the shoulder joint. Adhesions, or abnormal bands of tissue, grow between the bones of the shoulder joint and severely limit movement. In addition, the normal synovial fluid found in the shoulder joint begins to disappear, causing further pain and restricted motion.

What are the causes and risks of the condition?

This condition can occur after an injury to the shoulder, chest, or head. Any injury that prevents normal shoulder or arm movement may result in a frozen shoulder. Other risks for frozen shoulder include:

  • heart attack
  • chest surgery, such as open heart surgery
  • breast surgery, such as a modified mastectomy for breast cancer
  • brain surgery, which may follow head injury
  • Type I diabetes
  • hypothyroidism
  • Parkinson's disease
  • Frozen shoulder is most common in middle-aged women or people who have depression.


    Symptoms & Signs

    What are the signs and symptoms of the condition?

    Symptoms include severe shoulder stiffness and pain when trying to raise or use the arm.


    Diagnosis & Tests

    How is the condition diagnosed?

    The diagnosis is usually based on a physical exam , which reveals limited shoulder motion that cannot be explained by an injury or disease. Tests of the shoulder joint may include:

  • joint x-ray, with or without the injection of contrast media
  • MRI, or magnetic resonance imaging

  • Prevention & Expectations

    What can be done to prevent the condition?

    In most cases, frozen shoulder can be avoided with prompt treatment of the initial injury and active use of the shoulder. Physical therapy can be useful in promoting proper use of the joint.

    What are the long-term effects of the condition?

    A possible long-term effect is chronic shoulder stiffness resulting in loss of strength and permanent disability.

    What are the risks to others?

    There are no risks to others as this condition is not contagious.


    Treatment & Monitoring

    What are the treatments for the condition?

    Stretching exercises are often prescribed to loosen the joint. The healthcare provider may inject the shoulder with cortisone or a long acting anesthetic. This can decrease some of the pain and allow the patient to stretch the shoulder more effectively. Medications such as non-steroidal anti-inflammatory drugs (NSAIDS) can decrease inflammation and pain. Physical therapy can be helpful to increase the range of motion in the joint. Manipulation of the shoulder under anesthesia, also known as arthroscopic capsular release, may be required if exercises and medications are unsuccessful.

    What are the side effects of the treatments?

    Rarely, shoulder manipulation can cause a torn ligament or tendon, or even a shoulder fracture. Allergic reactions may occur with injection of cortisone or an anesthetic.

    What happens after treatment for the condition?

    Individuals are encouraged to maintain range of motion by doing daily exercises.

    How is the condition monitored?

    The healthcare provider will check shoulder range of motion during regular follow-up visits until the problem has resolved.


    Attribution

    Author:John A.K. Davies, MD
    Date Written:
    Editor:Planko, Christa, MA
    Edit Date:05/02/00
    Reviewer:Pam Rosenthal, RN, BSN, CCM
    Date Reviewed:08/09/01