Frozen shoulder

What it is

Adhesive capsulitis, or frozen shoulder syndrome, is a disorder of the shoulder that results in marked stiffness and pain on attempts of motion.

How it starts

Many patients identify a specific event during which the problem started. Frequently it is a mild and surprisingly trivial one — reaching into the back seat of a car for a handbag.

What it stops you doing

Most patients notice that the functional window in which the arm can move progressively narrows, to the point that even simple movements become very difficult. Tucking in a shirt, fastening a brassiere, reaching for the seatbelt — all of these can be very difficult and even impossible with a frozen shoulder.

What is happening inside the joint

The shoulder joint capsule is normally loose and pliable. In adhesive capsulitis it tightens and contracts around the ball and socket joint. That restricts the joint’s ability to rotate and glide, and any attempt to move beyond this soft tissue restraint is met with sharp pain.

Who gets it

The most common group of patients with adhesive capsulitis in this practice are perimenopausal women, usually with pain in the left — the non-dominant — shoulder.

Diabetics and patients with thyroid disorders are also prone to the condition. When it occurs in someone with no obvious reason to get it, it is called idiopathic adhesive capsulitis.

How long it lasts

Untreated, a frozen shoulder typically lasts eighteen to twenty-four months.

How it is treated

What decides the treatment is not the scan. It is how bad the symptoms are, and what they are doing to your life.

Treatment usually consists of a comprehensive physical therapy program, usually incorporating water therapy at some point. Injections, therapy and, in some cases, a manipulation of the shoulder can improve motion and decrease pain.

Surgery is occasionally needed to help a patient overcome the stiffness. Where it is needed, it is usually an arthroscopic procedure.

What an MRI does and does not show

A frozen shoulder does not have a typical appearance on an MRI. The problem is a reduction in the volume of the joint capsule, and that does not show up the way a torn tendon does. A radiologist may sometimes suspect it from a reduced axillary pouch, but that is not nearly as strong a finding as, say, a full-thickness rotator cuff tear.

Many patients arrive having already had an MRI, ordered by a well-meaning primary care doctor or another physician. It shows the normal degenerative findings of their age group. Somewhere in the report is the word tear — often a small labral tear — and it is easy to believe that this must be the source of all the pain. A small labral tear is a normal finding in a fifty-year-old.

When there is a rotator cuff tear as well

Sometimes both are there at once: a genuine full-thickness rotator cuff tear and a frozen shoulder in the same shoulder. Even then, it makes sense to rehabilitate the shoulder and get the joint supple before repairing the cuff. Stiffness after a cuff repair, in someone who also had a frozen shoulder, makes for a very tough recovery.