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Frozen Shoulder | Loss of Motion

The shoulder joint is a ball and socket joint. The ball is the top of the arm bone (the humeral head), and the socket is part of the shoulder blade (the glenoid). Together these bones form the glenohumeral joint; this is the ball (humerus) and socket (glenoid)--the glenohumeral joint. Normally, the shoulder joint allows more motion than any other joint in the body. When frozen shoulder sets in, however, the limits in motion can make this a stiff and useless joint.

Frozen shoulder treatment primarily consists of pain relief and physical therapy. Exercises and stretching for frozen shoulder serves two functions:

  • First, to increase the motion in the joint
  • Second, to minimize the loss of muscle on the affected arm (muscle atrophy)

Frozen shoulder is characterized by a decrease in motion, primarily seen in lifting the arm and turning it inwards. Frozen shoulder is most common in the 40- 60 year old age group and it is twice as common in women as men. Most cases of frozen shoulder follow a specific pattern. Initially, there is an acute phase that is characterized by significant pain, difficulty sleeping and significant functional impairment. This is followed by a progressive stiffening phase when the shoulder motion worsens. The final phase is the resolution or thawing phase identified by the gradual return of both motion and function. The overall course is variable but can last 12 - 36 months.

The common causes of frozen shoulders are:

  • Hyperthyroidism (excessive production of thyroid hormones)
  • Diabetes
  • Heart/ circulatory diseases
  • A fracture or other arm injury
  • Shoulder injury/ surgery
  • Cervical disk disease
  • Degenerative arthritis
Shoulder Joint

While these common causes seem to be different, they all lead to any of the following two fundamental causes of frozen shoulder:

High density of impurity in the blood. The accumulation of impurities can settle down near the shoulder joints, muscle joints, and the belt of muscles and block the normal blood circulation in these areas, which in turn lead to shoulder pain and loss of motion in the shoulder joint.

Common causes such as:
Hyperthyroidism, Diabetes and Heart/Circulatory diseases can all lead to such high density of impurity in the blood.

Inflammation in the shoulder joint capsule. The capsule of a shoulder joint includes the ligaments that attach the shoulder bones to each other. When inflammation occurs within the capsule, there is less ability for the shoulder bones to freely move within the joint. For this reason frozen shoulder is also called adhesive (scarred) capsulitis (inflamed joint capsule).

Common causes such as:

  • A fracture or other arm injury, shoulder injury/ surgery, cervical disc disease, and degenerative arthritis can all lead to inflammation in the shoulder joint capsule.
  • The importance of therapy and exercises, as these are the key to successful frozen shoulder treatment. Physical therapists may also incorporate ultrasound, ice, heat, and other modalities into the rehabilitation for frozen shoulder.
  • Cortisone injections are also commonly used to decrease the inflammation in the frozen shoulder joint. Usually up to three injections can be given, spanning several weeks. After three injections, if improvement is not seen it is unlikely that more injections will alter the course of frozen shoulder treatment.

If the above treatments do not resolve the frozen shoulder, occasionally a patient will need to have surgery. If this is the case, the surgeon may perform a manipulation under anaesthesia. A manipulation is performed with the patient sedated under anaesthesia, and the doctor moves the arm to break up adhesions caused by frozen shoulder. There is no actual surgery involved, meaning incisions are not made when a manipulation is performed.

Alternatively, or in conjunction with a manipulation, an arthroscope can be inserted into the joint to cut through adhesions. This procedure is called an arthroscopic capsular release. Surgical capsular release of a frozen shoulder is rarely necessary, but it is extremely useful in cases of frozen shoulder that do not respond to therapy and rehab. If surgery is performed, immediate physical therapy following the capsular release is of utmost importance. If rehab does not begin soon after capsular release, the chance of the frozen shoulder returning is quite high.