Is Frozen Shoulder Permanent? (Discovered)

Frozen shoulder typically gets better with time, especially with physiotherapy. Those who continue to follow their treatment plan can expect full recovery.

A physical exam is usually enough to diagnose frozen shoulder, but your doctor may order x-rays or an MRI to rule out other conditions. They may also inject anesthetic into your shoulder to numb the area before moving your shoulder.

What Causes Frozen Shoulder?

Frozen shoulder develops from the gradual loss of movement in one of the body’s most mobile joints, a ball and socket type joint in your shoulder called the glenohumeral joint. The joint becomes inflamed and scar tissue forms as the tissues inside the joint shrink and harden, causing the shoulder to become stiff and immobile. Most people develop frozen shoulder over time without any specific injury. People with certain diseases and conditions are more likely to develop the condition, including thyroid disease, diabetes, and autoimmune disorders. In addition, people who have had a stroke or heart attack, or are recovering from surgery, may also be at risk.

Your health care provider can usually tell if you have a frozen shoulder by taking a history of your symptoms and doing a physical exam. They will press on your shoulder and ask you to move your arm in different positions. They might order x-rays or an MRI scan of your shoulder to rule out other problems that can cause pain and stiffness.

Once you have a diagnosis, you can do things to help improve your recovery and prevent the shoulder from becoming frozen again in the future. Most experts recommend continuing to do physical therapy for several weeks or months after your symptoms improve.

Some treatments, such as applying heat or ice to your shoulder, can relieve the pain and stiffness. Applying a warm compress for 15 to 20 minutes several times a day can be helpful. You can also take a warm bath or shower or use a heating pad. Some people find that taking nonsteroidal anti-inflammatory drugs (NSAIDs) helps with the pain and stiffness.

Your doctor may also inject your shoulder with glucocorticoid and saline to expand the joint. This has been shown to decrease pain and improve mobility, but it is unclear whether the improvement comes from the saline or the glucocorticoid. Some patients have reported better results with injections that target the suprascapular nerve, which provides sensation to the shoulder. But more research is needed in this area. Some people who do not get better with other treatment options might need surgery to release the shoulder joint. This is a safe and effective procedure that typically restores motion within about a year.

Symptoms

The head of your upper arm bone fits into a shallow socket in your shoulder blade. A thick covering called the shoulder capsule surrounds the joint, and tendons from your rotator cuff hold it in place. Synovial fluid lubricates the joint to allow it to move easily. In frozen shoulder, the tissue surrounding the shoulder becomes tight and stiff. Symptoms develop gradually. You may have pain, especially when moving your shoulder. It may hurt more when you reach overhead or into your back pocket. Your shoulder may also feel stiff or inflamed.

Your doctor diagnoses this condition by asking about your symptoms and examining your shoulder. Your doctor may order x-rays or an MRI of your shoulder to check for other problems. But these tests aren’t usually needed.

During the first phase, your doctor can help you manage pain and improve movement by giving you over-the-counter pain relievers (such as acetaminophen or nonsteroidal anti-inflammatory drugs, or NSAIDs) and steroid injections into your shoulder joint. Physical therapy is the cornerstone of treatment, especially exercises that stretch your shoulder joint capsule. It is important that you follow your therapist’s instructions and complete the therapy exercises every day.

Early treatment is important for a successful recovery. But you must realize that it will take several weeks or months to see progress. It is not unusual for full shoulder motion to never return.

Some doctors use a procedure that involves injecting your shoulder joint with a solution of sterile saline and corticosteroid. This is called hydro dilatation. This can stretch your joint capsule, and it is sometimes helpful during the freezing phase. It hasn’t been proven to help during the thawing phase of frozen shoulder.

Surgery isn’t commonly needed for frozen shoulder, but it might be needed if other treatments don’t work or if the problem doesn’t get better over time. During surgery, your surgeon removes the excess tissue from your shoulder joint. This is done under a general anesthetic. Afterward, your doctor may do physical therapy to help keep your shoulder in motion. You might need to continue with physical therapy for years after your surgery.

Diagnosis

Frozen shoulder is diagnosed by taking a detailed history and doing a physical exam. Your doctor might use X-rays or MRI (magnetic resonance imaging) to rule out other conditions that can cause pain and stiffness in your shoulder, such as a rotator cuff tear.

People who have thyroid disease, diabetes, a recent shoulder injury or surgery, or an autoimmune condition are at greater risk for developing frozen shoulder. It’s important to see a health care provider who specializes in shoulder problems for a diagnosis and treatment plan.

The first step in treating frozen shoulder is to reduce the pain and stiffness by following a doctor’s instructions for rest and physical therapy. Your health care provider might also prescribe medications to relieve pain, such as acetaminophen (synonymous with Tylenol) or nonsteroidal anti-inflammatory drugs (NSAIDs). These medications can be taken in pill form or through injections into the shoulder joint.

You should begin with gentle shoulder mobility exercises, and your doctor will gradually increase the intensity of your PT program. Physical therapy may last up to six weeks or longer, depending on your progress. During PT, your therapist will focus on stretching your shoulder’s joint capsule, as well as strengthening your shoulders.

Your PT program might include modalities such as short wave diathermy and electromagnetic stimulation to decrease pain and promote healing. It is important to follow your PT plan, as consistently attending PT will help you return to the range of motion you had before the beginning of your symptoms.

If conservative treatments aren’t working, your health care provider might recommend steroid injections into the shoulder joint. These medications, called glucocorticoids, can reduce pain and stiffness in the shoulder but only provide short-term relief. Health care providers usually inject glucocorticoids into the shoulder directly, rather than giving them in pill form.

Frozen shoulder often goes away on its own, although it can take up to three years for your shoulder to completely recover. Getting to this point requires patience and consistent commitment to your treatment. Ultimately, more than 90% of people with frozen shoulder improve with conservative treatment.

Treatment

Frozen shoulder is a disorder that can be painful and disabling. Fortunately, it is usually self-limiting and will improve on its own. A frozen shoulder treatment comes with a combination of medications, physical therapy and steroid injections. Some patients will need to modify their activities of daily living to avoid movements that aggravate the condition.

NSAIDs (such as paracetamol) may help with pain and swelling. Cortisone injections into the affected shoulder can be very helpful in reducing inflammation and improving mobility. However, this is a hit-and-miss procedure and is not effective in all cases.

The cornerstone of treatment is physiotherapy, starting with a thorough examination to learn what movements trigger symptoms and how limited your mobility is. Your physiotherapist can teach you exercises to perform at home which will stretch the shoulder capsule and slowly restore mobility. The key is to commit to regular physiotherapy sessions and do the exercises on a daily basis.

It can take many months to see improvements in the shoulder. You will need to be patient. Occasionally patients will reach the ‘thawing’ stage which means that movement is becoming easier, but it will still take some time to get back to your normal range of motion.

Most people with frozen shoulder are between the ages of 40 and 65. It is more common in women than men, although anyone can develop it. People with thyroid disease, diabetes, autoimmune conditions, and those who have had an injury or surgery can be at higher risk of developing the condition.

An ultrasound scan can show that the joint has become stiff and fibrotic. It is also useful in confirming the diagnosis and monitoring progress, particularly as a test before a cortisone injection.

Hydro dilatation, sometimes referred to as hydrodistension, involves filling the shoulder with saline fluid and sometimes adding a corticosteroid. The aim is to break up the adhesions that are causing the frozen shoulder. A recent study showed that this procedure is more successful than just a cortisone injection and significantly improved the speed of recovery.

A physiotherapist will often use this technique under fluoroscopic guidance to ensure that the needle is in the right place. Some patients will find that a steroid injection helps them and that the symptoms begin to subside within a few days, but it is important to keep up with the physiotherapy to ensure that the motion is restored.