Frozen shoulder is characterized by a decrease in motion, primarily seen in lifting the arm and turning it inwards. A frozen shoulder is most common in the 40 - 60 year old age group and it is twice as common in women as men. Most cases of frozen shoulder follow a specific pattern. Initially, there is an acute phase that is characterized by significant pain, difficulty sleeping, and significant functional impairment. This is followed by a progressive stiffening phase when the shoulder motion worsens. The final phase is the resolution or thawing phase identified by the gradual return of both motion and function. The overall course is variable but can last 12 - 36 months.
What Causes Frozen Shoulder?
The most common causes of frozen shoulders are:
Hyperthyroidism (excessive production of thyroid hormones)
Diabetes
Heart/ circulatory diseases
A fracture or other arm injury
Shoulder injury/ surgery
Cervical disk disease
Degenerative arthritis
While these common causes seem quite different, they all lead to any of the following two fundamental causes of frozen shoulder:
High density of impurities in the blood. The accumulation of impurities can settle near the shoulder joints, muscle joints, and the belt of muscles and block the normal blood circulation in these areas, which in turn can lead to shoulder pain and loss of motion in the shoulder joint. Common causes such as hyperthyroidism, diabetes, and heart/ circulatory diseases can all lead to such a high density of impurities in the blood.
Inflammation in the shoulder joint capsule. The capsule of a shoulder joint includes the ligaments that attach the shoulder bones to each other. When inflammation occurs within the capsule, there is less ability for the shoulder bones to freely move within the joint. For this reason a frozen shoulder is also called an adhesive (scarred) capsulitis (inflamed joint capsule). Common causes such as a fracture or other arm injury, shoulder injury/ surgery, cervical disk disease, and degenerative arthritis can all lead to inflammation in the shoulder joint capsule.
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Shoulder Pain
What causes pain in my shoulder?
A common cause of shoulder pain is soreness of the tendon (a cord that attaches a muscle to a bone) of the rotator cuff (the part of the shoulder that helps circular motion). Another common cause is soreness of the subacromial bursa (a sac of fluid under the highest part of the shoulder). You might have soreness after activities such as painting, lifting or playing a sport, which require you to lift your arms. Or you may not remember any specific injury.
The main joint in the shoulder is formed by the arm bone and the shoulder blade. The joint socket is shallow, allowing a wide range of motion in the arm. The rotator cuff is made up of 4 muscles that surround the arm bone. This cuff keeps the shoulder steady as the arm moves.
How does the rotator cuff get hurt?
The supraspinatus muscle rests on top of the shoulder. Its tendon travels under the bone on the outside of the shoulder (the acromion). This tendon is the one most often injured because of its position between the bones. As the tendon becomes inflamed (sore and swollen), it can become pinched between the 2 bones. The sac of fluid that cushions the tendon can also be damaged.
How do I know the rotator cuff is hurt?
If the rotator cuff is involved, the pain is usually in the front or outside of the shoulder. This pain is usually worse when you raise your arm or lift something above your head. The pain can be bad enough to keep you from doing even the simplest tasks. Pain at night is common, and it may be bad enough to wake you.
What can I do to help the pain?
Treatment should help your pain and help you restore your shoulder to normal function. Pain relief strategies include active rest (you can and should move your shoulder, but you shouldn't do strenuous activities like lifting heavy objects or playing tennis). Application of ice, taking nonsteroidal anti-inflammatory medicine such as ibuprofen (two brand names: Advil, Motrin) or naproxen (brand name: Aleve) and, occasionally, an injection of anti-inflammatory steroids can also help.
Normal function can be restored with special exercises. The first step of rehabilitation therapy is simple range-of-motion exercises. By bending over and moving (rotating) your shoulder in large circles, you will help to avoid the serious complication of rotator cuff injury, called a frozen shoulder. These range-of-motion exercises are followed by resistance exercises using rubber tubing or light dumbbells. The final step is resistance training with weight machines or free weights.
What exercises should I do?
The following exercises may help you (see pictures 1, 2 and 3). Check with your doctor to see if you should do other exercises, too.
What else can I do to help this injury heal?
An aerobic exercise program will help improve the blood flow to the tendon or bursa. This helps reduce soreness. Smokers should quit smoking so more oxygen reaches the injured tendon. This will help the injury heal faster.
Will I need surgery?
Sometimes an injury that lasts a long time will cause the tendon to tear. This type of injury may need surgery. A tear of the rotator cuff is suspected when the pain goes on in spite of a good rehabilitation program or when there is weakness in certain motions of the arm.
What Causes Frozen Shoulder?
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