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Frozen Shoulder

Introduction

Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by stiffness and pain in the shoulder joint.  Over time, the shoulder will become very hard to move.

Anatomy

The shoulder is a ball-and-socket joint made up of three bones: the upper arm bone (humerus), shoulder blade (scapula), and collarbone (clavicle).  The head of the upper arm bone fits into a shallow socket in the shoulder blade.  Strong connective tissue, called the shoulder capsule, surrounds the joint.  To help the shoulder move more easily, synovial fluid lubricates the shoulder capsule and joint.

Causes

The bones, ligaments and tendons that make up the shoulder joint are encased in a capsule of connective tissue.  Frozen shoulder occurs when this capsule thickens and tightens around the shoulder joint, restricting its movement.  Physicians aren’t always sure why this happens to some people and not to others, although it’s more likely to occur in people who have recently experienced prolonged immobilization of their shoulder, such as after surgery or an arm fracture.

Symptoms

Frozen shoulder typically develops slowly, and in three stages.  Each of these stages can last a number of months.  The first stage, the painful stage, occurs with any movement of your shoulder and your range of motion becomes limited.  In the second stage, or the frozen stage, pain may lessen; however, your shoulder may become stiffer and range of motion decreases further.  In the last stage, or the thawing stage, your range of motion begins to improve.  For some people, the pain worsens at night and can disrupt sleep.

Diagnosis

After discussing your symptoms and medical history, your doctor will examine your shoulder.  He or she will move your shoulder carefully in all directions to see if movement is limited and if pain occurs with the motion.  Other diagnostic tests, such as an X-ray or MRI may help your doctor to rule out other potential causes of stiffness and pain.

Treatment

The focus of treatment is to control pain and restore motion and strength through physical therapy.  The shoulder will generally get better over time, and no surgery is usually needed.  Your therapist can show you specific exercises to help regain range of motion.  The therapist also may decide to use treatments such as heat and ice to help relax the muscles prior to other forms of treatment.  You will be given a home exercise program designed to reduce the loss of motion.

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