Frozen Shoulder Frequently Asked Questions

The shoulder is the most mobile joint in the human body with a complex arrangement of bone and
soft tissue (ligaments, tendons, and muscles) that work together to produce shoulder movement.
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Frozen shoulder, also called adhesive capsulitis, is a thickening and tightening of the soft tissue
capsule that surrounds the glenohumeral joint, the ball and socket joint of the shoulder. Click here
for more information.

Primary adhesive capsulitis and secondary adhesive capsulitis are the two types for frozen shoulder.
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Primary adhesive capsulitis is a subject of much debate. The specific causes of this condition are not
yet known. Possible causes include changes in the immune system, or biochemical and hormonal
imbalances. Diseases such as diabetes mellitus, and some cardiovascular and neurological disorders
may also be contributing factors. In fact, patients with diabetes have a three times higher risk of
developing adhesive capsulitis than the general population. Primary adhesive capsulitis may affect
both shoulders (although this may not happen at the same time) and may be resistant to most forms
of treatment. Click here for more information.

Secondary (or acquired) adhesive capsulitis develops from a known cause, such as stiffness
following a shoulder injury, surgery, or a prolonged period of immobilization. Click here for more
information.

The major symptoms of frozen shoulder are pain and loss of motion. Click here for more information.

Physical therapy is helpful in certain cases. Secondary adhesive capsulitis is generally more resistant
to non-operative treatments. In some cases non-steroid anti-inflammatory medications can be helpful.
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Operative procedures to treat frozen shoulder include closed manipulation, arthroscopic and open
surgical techniques. Click here for more information.

Complications after frozen shoulder surgery are generally infrequent. The most common problems
associated with any of these procedures result from too little release, or (very rarely) from too much
release. Fractures of the humerus have been reported with closed manipulation. Older patients with
fragile bones (osteoporosis) are more at risk for this type of complication. In rare cases, previous
surgical repairs have been damaged. Although arthroscopic releases are relatively safe, releases in
certain areas inside the joint have led to nerve injury. Click here for more information.

The recovery from non-operative treatment of frozen shoulder can take one to three years. It is
important for patients with frozen shoulder to understand the natural course of the disease and how
long it can persist. A home stretching program, combined with a supervised program with a skilled
therapist, can speed the recovery process in many cases. Click here for more information.

Patients usually remain in the hospital for one or two days with pain medication being delivery to the
joint through a catheter. Patients begin physical therapy program while in the hospital and continues
for over three months. Sutures should be kept clean, dry, and cover until removed during an office
visit after ten days. Click here for more information.

The resolution of a frozen shoulder can be very slow, but physical therapy can speed up the healing
process. Usually when the pain starts to subside physical therapy can be effective in stretching the
capsule back out. Occasionally in unmanageable cases surgery is indicated. This is true only in cases
in which the pain has subsided and the residual capsular contracture has not responded to six
months or more of physical therapy. Click here for more information.

Surgery in the face of a frozen shoulder is not recommended because of the immobilization required
after a rotator cuff repair. The shoulder becomes more inflamed after the surgery and the
immobilization required to heal the cuff repair leads to increased stiffness. The only way to deal with
this combination of problems is to allow physical therapy to stretch out the frozen shoulder. Once that
has been accomplished, the rotator cuff repair can be performed. The shoulder will probably be stiffer
than the average cuff repair after the immobilization period ends, but research has shown that
physical therapy can help regain lost motion. Click here for more information.