Frozen Shoulder

This post will focus on frozen shoulders as in frozen not moving, not frozen as in cold outside.  The most common story is that someone will notice, they can no longer reach above their head, behind their back, or off to their side without severe amount of pain. They have trouble in the shower, drying off, putting on underarm deodorant, and getting dressed. They have trouble at the box pressing or jerking overhead. The basic problem is loss of motion in the joint capsule as seen here. The capsule instead of being loose and floppy to allow for 180 degrees of motion becomes tight and constricted. This prevents the arm from moving typically in front and off to the side.

Image credit: http://www.arisemobility.co.uk/health-benefits/frozen-shoulder/


So you can see this is something that can bother people on a daily basis if not a few times a week. From a CrossFit point of view, athletes will have trouble getting the bar above their head, unable to maintain a full range of motion. If they are diligent, they will notice that during daily stretches one arm is asymmetrically stiffer. You can see below the right shoulder has decreased range of motion.

When someone comes in to the office, I examine them and see if the stiffness and loss of motion is coming from other conditions.  These possibilities would be a rotator cuff tear or arthritis. A good physical exam can help distinguish between a frozen shoulder and a rotator cuff tear. An X-ray can help distinguish between a frozen shoulder and arthritis. People with frozen shoulders typically have good strength even though it is painful to use. People with a rotator cuff tear will notice weakness AND pain. As you can see, the reason arthritis can mimic a frozen shoulder is that the joint has lost its normal contour and you develop mechanical reasons or a block to full range of motion. 

Image credit: http://www.guildfordupperlimb.co.uk/shoulder/shoulder-arthritis

MRI can show a thickening of the ligaments which restricts the joint from normal motion.

Image credit: http://www.shoulderorthopaedist.com.au/shoulder-conditions/frozen-shoulder/

So after the diagnosis has been established, the first question people have is “why did this happen?”  The most common answer is we don’t know, so we call it idiopathic. The word idiopathic means even in the year 2017 we don’t know why or how people get this. We do know it is more common in people who have diabetes or thyroid disorders.

So now what happens after you have a diagnosis? Typically the shoulder pain goes away and the range of motion improves on its own. HOWEVER, this can take for an average case 4 months to a year. Sometimes a cortisone will relieve the terrible pain that can occur with it. As you can see, there is inflammatory red hyperemic tissue that is painful and tight.

The lining of the joint becomes very inflamed. The other word for frozen shoulder is adhesive capsulitis because of the inflammatory tissue seen at the time of arthroscopy. Therapy exercises and stretching are necessary to improve the flexibility of the joint. Home stretching is helpful once the patient has a handle on what needs to happen. 

If the case is recalcitrant meaning after many months of stretching, things don’t improve, then surgery may be an option. Arthroscopic surgery would release the scar and allow the shoulder to move normally. A cautery device is used to cut the tissue and coagulate it to prevent bleeding.

Image credit: http://surgicaltechniques.jbjs.org/content/3/1/e2

During surgery the arm moves normally after the capsule is released. Physical therapy has to start right away to maintain the motion and prevent adhesions from developing again.

So if you’ve lost motion and have pain, an X-ray and exam is reasonable to see what is going on. Most importantly if there has been no fall or trauma you have to keep moving the shoulder. Move it or lose it is the key. Move quickly and aggressively. Don’t get cold feet when it comes to frozen shoulders.

 

 

 

 

2 Comments

  1. you need to see your doctor

  2. My pain start’s on top of my arm right before my elbow, and travels into my elbow but on my funny bone side & then up the back of my arm into my shoulder. I can’t lift my hand above my head or even comb my hair. My first cortisone shot was administered on the front of my shoulder & lasted 2 years. Now it’s back, got another shot & it only lasted one day. It’s so painful I have to hold my elbow with pressure & that still don’t help. I wish I could get a whole new arm, it’s that bad. What can or should i do ? Soon !

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About Me

Dr. Sean Rockett is an Orthopedic Surgeon specializing in Sports Medicine. His group is Orthopedics New England with offices in Dedham, Natick and Newton, Massachusetts. Dr. Rockett is a CrossFit Level 1 Trainer and has been a CrossFitter at CrossFit New England since 2007. Dr. Rockett is on the Medical Team for the CrossFit Games and the Northeast Regionals.

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