Ask An Expert: Frozen Shoulder

Content provided by the Faculty of the Harvard Medical School

Ask An Expert: Frozen Shoulder

Question:

I have been getting physical therapy for what is called a "frozen" shoulder. Can you give me more information on this condition?

Answer:

The shoulder normally has more range of motion than any other joint in the body. Perhaps because of this, it also has a tendency to lose motion if not used. A "frozen shoulder" is a condition in which the shoulder has limited motion in all directions. Frozen shoulder is not a single disease; instead, it may complicate any disorder in which the shoulder is painful or doesn't move for at least two or three weeks. Special X-rays performed after dye is injected into a frozen shoulder often show the space surrounding the joint (the joint capsule) to be markedly reduced, especially if the condition has been longstanding. Why this constriction of the joint capsule (also called "adhesive capsulitis") occurs is not known.

Common conditions that may lead to frozen shoulder include ones that cause prolonged pain (bursitis - LINK, tendonitis- LINK), or various forms of (arthritis -LINK) or ones in which there is a prolonged reduction in motion (stroke, tendon injury, fracture or simply wearing a sling too long without moving the shoulder around). For uncertain reasons, people with diabetes are also at risk for developing frozen shoulder, perhaps because they are also prone to tendonitis and bursitis.

Treatment for frozen shoulder includes:

• Treatment of the underlying condition

• Exercises to retain what motion remains and to prevent further loss of motion

• Reduced use of a sling or any other device that limits motion

• Pain and anti-inflammatory medications (including occasional injections of cortisone, a powerful anti-inflammatory agent)

Surgical treatment is sometimes offered for severe cases that do not respond to more conservative therapies. Surgical approaches include arthroscopic surgery, in which a small tube with a camera and light on the end is inserted into the shoulder and the joint capsule is dilated; and forced motion of the shoulder while under anesthesia. The increased pain just after surgery and the uncertain benefit have lead many health care providers to abandon the latter option.

The treatment outcomes for frozen shoulder are not routinely positive, especially if adhesive capsulitis has developed; some significant limitation of motion is often longstanding or even permanent. Preventing the condition in the first place is a priority. This is why health care providers often recommend physical therapy and exercise for many conditions in which reduced or painful shoulder motion is prominent.

Robert Shmerling, M.D., is associate physician and clinical chief of rheumatology at Beth Israel Deaconess Medical Center and an associate professor in medicine at Harvard Medical School. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program and has been a practicing rheumatologist for over 25 years.

E-mail This | Print This

Last updated:	January 24, 2007