A frozen shoulder, or adhesive capsulitis, is a stiffening of the joint between the glenoid (cup) and humeral head (ball). The shoulder is normally a highly mobile joint that allows the arm to do all the amazing movements it does ranging from throwing a bowling or bocce ball underhand to throwing a baseball overhand. When a shoulder loses range of motion there are generally two causes, arthritis and frozen shoulder.
Frozen shoulder is caused by an abnormal thickening of the shoulder joint capsule. This can occur both idiopathically (no known reason) and secondarily. Secondary frozen shoulder can occur after trauma causing a contusion, fracture or tendon tear or even after a shoulder surgery. The cause of idiopathic, or primary frozen shoulder is not known. It is known, however, that it usually occurs in females between the ages of 40 and 60 years of age. It is believed that it may be related to hormonal changes associated with menopause. Idiopathic frozen shoulder can also occur spontaneously in diabetics. When it does occur in a diabetic, it often does not resolve as easily as it does in the non-diabetic patient.
Idiopathic frozen shoulder usually occurs in phases and will usually resolve in 12-24 months. The initial phase is called the Freezing Phase. During this phase there is usually an insidious onset of intense deep pain with progressive loss of motion. The second phase is called the Frozen Phase. During this phase, the range of motion is stable. It neither improves nor does it worsen. The pain usually improves slightly during this time. The last phase is referred to as the Thawing Phase. During this phase, the shoulder pain continues to improve and the range of motion slowly improves. In diabetics and in secondary frozen shoulder, the final phase may never occur. In this situation, surgical intervention may be required to improve the shoulder pain and function.
This care usually involves an intensive physical therapy regimen to help regain range of motion with the shoulder as well as anti-inflammatory medications. In idiopathic frozen shoulder the shoulder can normally return to function without surgical intervention. Secondary frozen shoulder has less success with non-operative care.
When indicated, Dr. Lenarz’s preferred surgical management of frozen shoulder typically involves an arthroscopic procedure with release of the thickened capsule. Even with operative treatment, an intensive physical therapy regimen is still essential to an optimal recovery. Without dedicated therapy the frozen shoulder can recur and become more difficult to treat.