Thawing a painful frozen shoulder

By Adam Smith, M.D.

Frozen shoulder is a relatively common problem affecting up to two percent of the population. It is defined by significant limitation of active and passive motion in an otherwise normal shoulder.

Patients with frozen shoulder often have intense pain, as well as loss of motion that is often severe. These patients have no other causes for stiffness, such as rotator cuff tearing or osteoarthritis, that would limit motion or function.

What causes “frozen shoulder?”
While the cause of frozen shoulder is not known, the lining of the shoulder, called capsule, becomes thickened and stiff. Several systemic diseases have been associated with frozen shoulder, including diabetes, heart disease and thyroid disorders. Diabetics are at highest risk, with up to three in 10 patients experiencing frozen shoulder in their lifetime.

Imaging studies, including X-rays and MRI, can be helpful to rule out other causes of shoulder stiffness. Laboratory tests also may be useful.

Frozen shoulder goes through three basic stages: The inflammatory stage with acute pain, followed by severe stiffness, and, finally, recovery. In the acute pain phase, patients often have disabling night pain that makes sleep difficult.

How is “frozen shoulder” treated?
Pain may be difficult to control with oral medications, including nonsteroidals or narcotics. As the acute pain phase diminishes, patients are left with a stiff shoulder with pain at the endpoints of motion.

Medications can be useful to control pain in the short term. Over-the-counter medications, such as Tylenol, Aleve and Ibuprofen, can be helpful. Narcotics can be used for short periods of pain relief.

Steroid injections have been shown to be beneficial and are particularly helpful at relieving pain at night. These injections can be repeated at intervals to maximize their effect.

Physical therapy is the mainstay of treatment. Patients can be taught specific exercises and stretches to gradually help increase motion. Physical and occupational therapists are helpful in this phase of treatment and offer expertise on proper technique and different approaches to maximizing pain relief and motion.

How successful is nonoperative treatment? At least 90 percent of patients can be treated successfully with a non-operative approach. Symptoms usually resolve by six months, but may take as long as 12 months for full recovery.

What if the shoulder remains “frozen?”
Patients with continued stiffness and pain despite an adequate trial of nonoperative treatment may be candidates for surgery. Surgery is usually outpatient with a goal to restore as much motion as possible. Following surgery, a vigorous therapy regimen is used to maintain and maximize long-term function.