Frozen Shoulder

What is it?

Frozen shoulder is a term used to describe a shoulder which is stiff. The patient notices loss of motion usually in more than one direction.

• Stage 1: “freezing” stage;
• Stage 2: the “frozen” stage; and
• Stage 3: the “thawing” phase.

Stage 1 is usually characterized by pain, which proceeds loss of motion. Stage 2 is accompanied by loss of motion. And stage 3 is characterized by gradual improvement of motion.

Treatment

Mild frozen shoulder: the majority of patients will get better with either no therapy or with a supervised physical therapy program of gentle stretching

CORTISONE INJECTION: In patients with severe pain and mild loss of motion, injection of cortisone into the joint may provide dramatic relief and possible shorten the time course for recovery

MANIPULATION UNDER ANESTHESIA: This method involves manipulation of the shoulder under anesthesia in order to disrupt adhesions and restore motion. While it has been shown to be effective, complications such as fracture, nerve injury and dislocation have been described.

ARTHROSCOPIC CAPSULAR RELEASE: The arthroscope is inserted from the back of the shoulder and the tight capsule in the front of the upper portion of the joint is released. The posterior capsule is also released.

Below are intraoperative images taken during arthroscopic surgery to remove scar tissue and release the shoulder capsule. The image on the left reveal synovitis with capsular scarring (red - inflamed & painful tissue). The image on the right after removal of synovitis and capsular scarring.

OPEN RELEASE: In patients where the extent of adhesions is too significant for an arthroscopic approach, or the tendons outside the shoulder have been scarred, an open surgical release is required. The steps involve and incision and release of the adhesions between tissue planes, and sometimes lengthening of tendons.