Frozen shoulder can develop after a shoulder is immobilized for a period of time. Attempts to prevent frozen shoulder include early motion of the shoulder after it has been injured. The causes of frozen shoulder are not fully understood. The process involves thickening and contracture of the capsule surrounding the shoulder joint. Some physicians have described the normal course of a frozen shoulder as having three stages:
- Stage one: In the "freezing" stage, the patient develops a slow onset of pain. As the pain worsens, the shoulder loses motion. This stage may last from six weeks to nine months.
- Stage two: The "frozen" stage is marked by a slow improvement in pain, but the stiffness remains. This stage generally lasts four months to nine months.
- Stage three: The final stage is the "thawing," during which shoulder motion slowly returns toward normal. This generally lasts five months to 26 months
Pain due to frozen shoulder is usually dull or aching. It can be made worse with attempted motion. The pain is usually located over the outer shoulder area and sometimes the upper arm.
The hallmark of this disorder is restricted motion or stiffness in the shoulder and an inability to move the shoulder normally.
Frozen shoulder will generally get better on its own. However, this takes some time, occasionally up to two to three years. Treatment is aimed at pain control and restoring motion through nonsurgical or surgical means.
Pain control can be achieved with anti-inflammatory medications and physical therapy. These can include pills taken by mouth, such as ibuprofen, or by injection, such as corticosteroids. More than 90 percent of patients improve with these relatively simple treatments. Usually, the pain resolves and motion improves. However, in some cases, even after several years motion does not return completely and a small amount of stiffness remains.
Surgical intervention is considered when there is no improvement in pain or shoulder motion after an appropriate course of physical therapy and anti-inflammatory medications. Surgical intervention is aimed at stretching or releasing the contracted joint capsule of the shoulder. The most common methods include manipulation under anesthesia and shoulder arthroscopy.
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