Frozen shoulder is a descriptive term for a problem in which a shoulder begins to lose motion just as if it were “frozen”. This is a very well described but poorly understood problem. It is more common in women than men and most commonly occurs in the 50’s. Far and away the most common history is for the shoulder to develop stiffness spontaneously. However, a frozen shoulder can occur after a minor trauma, a fracture, after extremity surgery or sometimes even with neck pain. Whatever the cause, the shoulder begins to lose motion and becomes stiff. As the arm stiffens it is painful to push the shoulder to the extremes of motion. The natural tendency is to restrict the motion from these painful portions of the range of motion. The shoulder then becomes stiffer. Finally, it’s painful to move to new areas and it becomes a vicious cycle to where the shoulder is so painful the individual cannot even raise the shoulder above eye level.

It is unclear what exactly causes a frozen shoulder but probably begins with an inflammation of the capsule (the housing around the shoulder joint). We do know that the reason the shoulder motion is restricted is that the capsule shrinks, just as “heatshrink” plastic wrap on packaging. As this capsule contracts, the shoulder volume decreases and the shoulder gets progressively tighter. No one understands why but this can be caused by several different mechanisms.

Treatment consists of exercise, exercise and more exercise! This is one area of medicine where you should definitely work to the point of discomfort. Usually simple exercises at
home are all that is necessary. Occasionally formal physical therapy is required.

Even more rarely, a manipulation under anesthesia or even an arthroscopy is necessary. This is a procedure where you are put to sleep and the surgeon stretches the shoulder to achieve full range of motion. Usually only one manipulation is necessary. Afterward aggressive physical therapy is necessary to maintain the new gains in motion.

At least one research study has shown that if left alone a frozen shoulder almost always improves. Unfortunately this takes 5-7 years and few people are willing to wait that long. Therefore, the more aggressive approach is the one that is usually recommended. Either way, the long term results are usually good and doesn’t usually lead to arthritis or restricted range of motion.

2010 © G. Klaud Miller M.