Frozen Shoulder

Frozen shoulder, also called adhesive capsulitis, develops when the sleeve of tissue around the shoulder joint becomes inflamed, then gradually scars, thickens, and contracts. As the capsule tightens, the joint loses room to move, so the stiffness affects motion in every direction and is just as pronounced when someone else moves the arm. It tends to move through a painful phase, a stiff phase, and a gradual recovery phase. Most people regain full or near-full motion over time.

The early sign is a deep, aching shoulder pain that is hard to pinpoint. Common symptoms include:

• A deep ache across the front and outer shoulder, often worse at night
• Stiffness that builds and limits motion in every direction
• Trouble reaching overhead, behind the back, or across the body
• Restriction that is equally present whether you move the arm or someone else does

The diagnosis is made on a focused physical exam. When your provider moves the arm, the motion is restricted in every direction just as it is when you move it yourself, and turning the arm outward is usually the most limited. X-rays are taken to check for arthritis or a prior fracture and are typically normal. An MRI is not routinely needed.

The goal is to shorten each phase and keep pain manageable while the shoulder works through it:

• Physical therapy with gentle, sustained stretching that stays short of the pain threshold
• Anti-inflammatory medication to ease night pain and the inflammatory ache
• A corticosteroid injection into the joint, one of the most effective early treatments
• Hydrodilatation, which gently distends the capsule with fluid, when motion has not responded

Surgery is reserved for the minority who remain severely restricted after a sustained trial of therapy and injections. The procedure releases the thickened, contracted capsule, usually combined with a controlled movement of the shoulder under anesthesia.

• Shoulder arthroscopyShoulder

For a fuller explanation, including anatomy, diagnosis, and the full range of treatment:

• Frozen Shoulder (Adhesive Capsulitis) — AAOS OrthoInfo