Physician Blog by Edward J. Bieber, MD
Shoulder Pain – Frozen Shoulder
Frozen shoulder (adhesive capsulitis) is a loss of both active and passive motion of the shoulder with a gradual onset without a clear underlying cause. Patients can get stiff shoulders after a traumatic event or shoulder surgery but, although these may resemble adhesive capsulitis, they are very different entities. True adhesive capsulitis is much more common in women and usually occurs between 40 and 60 years of age. It is an inflammatory process with thickening of the shoulder joint capsule, fibrous scar tissue formation and adherence of the capsule to the humerus (upper arm bone) and formation of abundant Type III collagen which leads to a mechanical block. It has a higher association with diabetes, Dupuytren’s contracture, heart disease and autoimmune disorders, specifically autoimmune thyroid disease. The diagnosis is often one of exclusion since it is often confused with other sources of shoulder pain, making it very important to be evaluated by an experienced shoulder surgeon.
The structures that are most affected are the capsule and multiple ligaments of the shoulder. It is divided into 3 stages:
1. Freezing/Painful – diffuse pain for 6 weeks to 9 months
2. Frozen/Stiff or Plateau – pain diminishes but movement limitation persists for 4-9 months
3. Thawing – Gradual return of motion at 5-26 months but possibly not back to normal
The most common symptoms are pain that varies in intensity and stiffness.
The evaluation begins with a careful history and physical exam to rule out other sources of the patient’s symptoms. Laboratory studies, including testing for diabetes and inflammatory conditions, are part of the initial work up. A complete x-ray series is also recommended. MRI or MRA (MRI with a dye injection) is useful to rule out other problems but is not considered diagnostic for this problem.
Treatment is primarily non-surgical using NSAIDs (non-steroidal anti-inflammatory drugs such as Advil or Aleve), steroid injections and heat. The timing of starting physical therapy is controversial and many surgeons feel that it should wait until late stage 2 or stage 3 since starting too early may increase the inflammation. Other treatments such as manipulation under anesthesia and arthroscopic releases are reserved for cases that are not showing progress in a reasonable period of time.
For more information or treatment, please make an appointment.
– Edward Bieber, M.D.
Dr. Edward Bieber of OrthoBethesda is the area’s most experienced total shoulder surgeon.
He has been performing anatomic total shoulders since 1986 and reverse total shoulders since 2007. He employs an integrated program of state of the art surgery with the OrthoBethesda physical therapy team to achieve superior results with both types of shoulder replacements. He has extensive experience with computer assisted directional devices and custom made devices for patients with significant bone deformity. Read more here and make an appointment with Dr. Bieber today.