Frozen shoulder syndrome (FSS) is a diagnosis given to people with a painful loss of movement and stiffness in the shoulder. Also known as Adhesive Capsulitis, this syndrome affects 2-5% of the population at some point in their life.
The cause of this condition is not known, but studies have shown that the pain and lack of motion are most commonly due to a thickening of the joint capsule that surrounds the joint. The joint capsule is a leather-like substance that helps to keep the joint in place. As this capsule thickens, it will not allow for much movement, this irritation causes inflammation, which generates the resulting pain.
Although it is unknown why the shoulder does this, there are some known risk factors. Women are more likely than men (60% of cases are found in women), and people with pre-existing health disorders, especially Diabetes, seem to experience FSS more often. Another common predecessor for FSS is any sort of surgery on the upper arm or chest. Individuals who have recently had an open heart surgery, mastectomy, or any sort of shoulder surgery seem to have a 5-10 time greater chance of suffering from this disorder in the near future.
The bad news; this disorder can take from 3 months to 3 years to completely resolve. The good news is that most cases of FSS will resolve on their own with time. Clinically there are 3 phases. Stage 1 “Freezing:” when the shoulder starts to become painful, for no apparent reason, and we start to see the first loss of motion. Stage 2 “Frozen:” when the shoulder is the stiffest, but there seems to be less pain in the range of motion that is present. Stage 3 “Thawing:” The final stage when the range of motion slowly returns to normal, and there is minimal to no pain. This last stage usually takes the longest, ranging from 3 months to 2 years.
Treatment is considered optional since most of these disorders will resolve on their own. The main goal of treatment is to maintain the motion of the joint. This is commonly done with physical therapy, exercise, chiropractic, acupuncture, or massage therapy. During this time pain is usually controlled with anti-inflammatory medications taken either orally, or in more severe cases, steroids can be injected into the joint. More than 90% of cases can be relieved with these methods, but in the most severe cases, there are two other options.
Manipulation under anesthesia is a process where the patient is “put under” anesthesia, and the shoulder is forced through various ranges of motion to restore proper function. The anesthesia is used so the patient will not have to endure the pain of this technique. The second option is arthroscopic surgery to cut small incisions into the joint capsule in an effort to get it to “loosen up.” Both of these procedures are typically effective if followed up with a good physical therapy regime.
New research is currently under way to determine the exact cause of this disorder. In an effort to help prevent this disorder, doctors are routinely recommending different types of therapy and exercise at the first onset of shoulder pain. This is done to help maintain the motion of the joint and hopefully prevent any further problems such as frozen shoulder syndrome.