The complex ability of the shoulder to move any direction in space is what sets this apart from virtually all other joints. The loss of motion occurs in two major scenarios: the first is with arthritis, or when there is a loss of the cartilage ballbearings of the shoulder; the second condition is with a thickening of the lining coined adhesive capsulitis.

The lining of the shoulder is called the capsule. Normally, the capsule is a few millimeters thick. However, some variations of adhesive capsulitis may render this 10-15 millimeters thick. As the capsule thickens, it becomes less pliable and restricts shoulder motion.

Adhesive capsulitis comes in one of two varieties. The first is what is known as primary adhesive caspsulitis. For no apparent reason, the shoulder spontaneously freezes. The loss of motion is dramatic, and as the shoulder first loses motion, may be painful. There is an association with thyroid disorders or diabetes, and may affect both shoulders at some point in 10-15% of people developing the primary frozen shoulder. The typical patient is a female in her forties to fifties. The frozen shoulder typically will run its course and "dethaw" 6-24 months spontaneously after its onset. Physical therapy and steroid shots help slightly, but not as much as we would like. After the frozen shoulder loosens up, there often is a slight permanent loss of rotation (reaching up behind the back).

The second variety of a frozen shoulder is coined a secondary adhesive capsultis. The shoulder has another issue leading to pain (often a rotator cuff tendonitis or tear), and the capsule thickens in response to pain. The loss of motion of a secondary frozen shoulder is significantly less severe than that of a primary frozen shoulder. As the primary pathology is treated, the frozen shoulder improves. Therefore, corticosteroid injections and physical therapy are much more effective in this group than in the primary frozen shoulder group.

TREATMENT

1) Get an accurate diagnosis. As stated, primary and secondary frozen shoulders are treated very differently
2) Physical therapy. While therapy may not be very successful in stubborn primary cases, it is very worthwhile to consider due to the low complication rate.
3) Corticosteroid injection. A steroid shot often may help any discomfort (especially in a secondary frozen shoulder scenario), and may make the therapy more effective
4) Manipulation under anesthesia. For individuals with severe adhesive capsulitis, and frustrated by their loss of motion, a manipulation under anesthesis may be performed. Under an anesthetic, the shoulder is manipulated and moved and the scarred capsule is torn. There approximately is a 20% failure rate.
5) Arthroscopic capsular release. The contracted capsule and ligaments are surgically incised. There is a 5% failure rate. It should be noted for stiffness after surgery a manipulation after anesthesia is not an option since a forceful movement may disrupt the repair, and an arthroscopic release would be the procedure of choice.
6) Time. Keep in mind a primary frozen shoulder often will spontaneously correct. Unfortunately, there is no good way to predict when that will happen.