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Cause

Adhesive capsulitis, more commonly referred to as frozen shoulder, causes pain, stiffness, reduced range of motion and immobility in the shoulder. Over time, the shoulder becomes increasingly difficult to move. Unfortunately, the causes of frozen shoulder are not fully understood. There is no clear connection to arm dominance or occupation. However, a few factors may put you more at risk, including:

• Diabetes: Frozen shoulder occurs much more commonly in people with diabetes, but the reason for this is unknown. In addition, diabetic patients with frozen shoulder tend to have a greater degree of stiffness that continues for a longer time before “thawing” occurs.
• Other diseases: Some additional medical problems that may be associated with frozen shoulder include hypothyroidism, hyperthyroidism, Parkinson’s disease and even cardiac disease.
• Immobilization: Frozen shoulder can develop after a shoulder has been immobilized for a period of time due to surgery, a fracture or some other injury. Having a patient move the shoulder soon after injury or surgery is one measure prescribed to prevent frozen shoulder.

Stages

The condition comes in three stages:

• Stage 1: Freezing – During the freezing stage, a patient experiences increasing pain. As that pain increases, range of motion will continue to diminish, often lasting from six weeks to nine months.
• Stage 2: Frozen – During the frozen stage, pain may decrease, but the stiffness and loss of range of motion will remain. This stage lasts four to six months, and during this time, daily activities often become increasingly difficult.
• Stage 3: Thawing – During this stage, the restricted range of motion slowly begins to improve. The return to 100% complete range of motion and strength typically takes six months to two years.

Symptoms

Pain from frozen shoulder is usually described as a dull or aching pain. It’s typically worse early in the course of the disease and when the arm is in motion versus at rest. The pain is usually located over the outer shoulder area and sometimes the upper arm.

Treatments

Frozen shoulder generally gets better over time, although it can take up to three years for a full recovery. The focus of treatment is to manage the pain and restore full range of motion and strength through physical therapy.

Most people with frozen shoulder improve with relatively simple treatments to manage pain and restore a full range of motion. Nonsurgical options include:

• Non-steroidal anti-inflammatory medicines: Drugs like aspirin and ibuprofen may help in reducing pain and swelling.
• Steroid injections: Cortisone is a powerful anti-inflammatory medicine that’s injected directly into the shoulder joint.
• Hydrodilatation: If symptoms are not relieved by other nonsurgical methods, a doctor may recommend hydrodilatation – a procedure in which a large volume of sterile fluid is injected into the shoulder joint to expand and stretch the shoulder joint capsule.
• Physical therapy: Specific exercises are often successful in helping to restore the range of motion. These exercises include:
  • External rotation – passive stretch: The patient stands in a doorway, bending the affected elbow to 90 degrees to reach the door jamb. With the hand in place, the body is rotated and held in place for 30 seconds. Relax and repeat.
  • Forward flexion – supine position: The patient lies on their back with their legs straight. Using the unaffected arm, the patient lifts the affected arm overhead for a gentle stretch. Hold for 15 seconds and slowly lower to start position. Relax and repeat.
  • Crossover arm stretch: The patient gently pulls the arm across the chest just below their chin as far as possible, without causing pain. Hold for 30 seconds. Relax and repeat.

If symptoms are not relieved by therapy and/or other conservative methods, a doctor may advise a surgical option. Surgery for frozen shoulder is typically offered during “Stage 2: Frozen.” The goal of surgery is to stretch and release the stiffened joint capsule. The most common methods include manipulation under anesthesia and shoulder arthroscopy.

• Manipulation under anesthesia: During this procedure, the patient is sedated while the doctor manipulates the damaged area, causing the capsule and scar tissue to stretch and/or tear. This releases the tightening sensation and increases the patient’s range of motion.
• Shoulder arthroscopy: In this procedure, a doctor cuts through tight portions of the joint capsule using pencil-sized instruments inserted through small incisions in and around the shoulder.

Cause

A torn rotator cuff weakens the shoulder – inhibiting daily activities such as sleeping, dressing or combing the hair, and it often becomes more painful and difficult with time. It’s one of the most common causes of pain and disability among adults.

When one or more of the rotator cuff tendons is torn, the tendon is no longer fully attached to the head of the humerus. In many cases, torn tendons begin with fraying and, as the damage progresses, the tendon tears completely.

There are two main causes of rotator cuff tears: injury and degeneration. For example, if a patient falls down on an outstretched arm or lifts something too heavy with a jerking motion, the rotator cuff can tear. This type of tear can occur in conjunction with other shoulder injuries, such as a broken collarbone or dislocated shoulder. However, most tears are the result of the tendon simply wearing down over time. This degeneration naturally occurs as the body ages.

Rotator cuff tears are more common in the dominant arm. If a patient has a degenerative tear in one shoulder, there is a greater likelihood of a rotator cuff tear in the opposite shoulder.

Types

There are two different types of tears:

• Partial tear: Also referred to as an incomplete tear, this means there is damage to the tendon, but the tendon is not completely severed.
• Full-thickness tear: Also referred to as a complete tear, this means there is complete separation of the tendon from the bone. With a full-thickness tear, there is basically a hole in the tendon.

Symptoms

The most common symptoms of a rotator cuff tear include:

• Pain at rest, particularly at night (affecting sleep), and especially if lying on the affected shoulder
• Pain when lifting and lowering the arm, or with specific movements
• Weakness when lifting or rotating the arm
• Crepitus or crackling sensation when moving the shoulder in certain positions

Treatments

The goal of any treatment is to reduce pain and restore function, and there are several options for a rotator cuff tear. To determine the best course of action, a doctor will consider factors such as age, activity level, general physical health and the type of tear.

In about 80% of patients, nonsurgical treatment relieves the pain and improves/restores shoulder function. Options include:

• Rest: A doctor may suggest rest and limiting activities in which the arm is lifted over the head, as well as prescribe a sling to help protect the shoulder and keep it immobile. Activity modification will be required to avoid shoulder pain.
• Nonsteroidal anti-inflammatory medication: Drugs like ibuprofen and naproxen reduce pain and swelling.
• Strengthening exercises and physical therapy: The exercise program will include stretches to improve flexibility and range of motion. Strengthening the muscles that support the shoulder can help to relieve pain and prevent further injury.
• Steroid injection: If rest, medications and physical therapy do not relieve the pain, an injection of a local anesthetic and a cortisone preparation may be helpful. Cortisone is a very effective anti-inflammatory medicine; however, it is not effective for all patients.

The advantage of nonsurgical treatment is that it avoids the major risks of surgery, such as infection, permanent stiffness, complications due to anesthesia and sometimes a lengthy recovery time. The disadvantages of nonsurgical treatment are that the size of a tear may increase over time, and activities and range of general motion may need to be limited as a result.

A doctor may recommend surgery if the pain does not improve with nonsurgical methods. Ongoing pain is the primary indicator for surgical candidacy. If a patient is very active and uses the arms for sports or daily work, a doctor may recommend surgery.

Surgery to repair a torn rotator cuff most often involves re-attaching the tendon to the head of the humerus (upper arm bone).