SHOULDER, FROZEN

General Information

DEFINITION--Pain and stiffness in the shoulder joint that progresses to inability to use the shoulder. In this case, "frozen" does not relate to freezing temperatures.

BODY PARTS INVOLVED--Shoulder tendons, bursa, joint capsule, muscles, blood vessels and nerves.

SEX OR AGE MOST AFFECTED--All ages, but most common in athletic adolescents and young adults.

SIGNS & SYMPTOMS

Early stages:

• Pain in the shoulder, often slight, that progresses to severe pain that interferes with sleep and normal activities. Pain worsens with shoulder movement.
• Stiffness in the shoulder that prevents normal movement. Reduced movement increases stiffness.

Later stages:

• Pain in the arm or neck.
• Inability to move the shoulder.
• Intolerable shoulder pain.

CAUSES--Minor shoulder injury or inflammation, such as bursitis or tendinitis, that worsens from lack of use. Adhesions (constricting bands of tissue) form with disuse in 7 to 10 days. Adhesions increase disuse. After 3 weeks of disuse, adhesions grow so severe that the joint cannot move.

RISK INCREASES WITH

• Neglect of minor injuries, including bursitis or tendinitis.
• Poor physical conditioning and occasional athletic activity.
• Diabetes mellitus.
• Peripheral vascular disease.
• Immobilization.
• Sedentary workers.

HOW TO PREVENT

• Obtain medical treatment for bursitis and tendinitis, including exercises to prevent formation of adhesions.
• Do regular stretching exercises.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and physical exam by a doctor.
• X-rays of the shoulder (arthrography) or MRI (See Glossary) of the shoulder.

APPROPRIATE HEALTH CARE

• Self-care after diagnosis.
• Doctor's treatment, including manipulation of the shoulder to break up adhesions. This is done in a hospital or outpatient surgical facility under general anesthesia.
• Physical therapy and exercises.
• Surgery may be necessary in severe cases to remove adhesions or repair the capsule.

POSSIBLE COMPLICATIONS

• Permanent shoulder disability and pain without treatment or with delayed treatment.
• Tearing of the shoulder capsule due to weakness and scar tissue.

PROBABLE OUTCOME--Usually curable with treatment and rehabilitation (but may take several months). Some heal spontaneously.

How To Treat

GENERAL MEASURES--

• Wearing a sling may help ease discomfort.
• Application of heat (warm compresses or heating pad) to the affected area helps relieve pain. For some patients, ice may be more helpful.

MEDICATION--

• Your doctor may prescribe: Nonsteroidal anti-inflammatory drugs. Injections of cortisone and local anesthesia into joints to reduce pain and inflammation.
• For minor pain, you may use non-prescription drugs such as aspirin.

ACTIVITY--

• Physical therapy and passive shoulder exercises.
• Resume your normal activities as soon as symptoms improve.

DIET--No special diet. Vitamins and mineral supplements don't help unless you can't eat a normal, well-balanced diet.

Call Your Doctor If

• You have symptoms of a frozen shoulder.
• You have persistent shoulder pain, indicating possible bursitis or tendinitis.
• New, unexplained symptoms develop. Drugs used in treatment may produce side effects.