Frozen Shoulder

Most of the common causes of shoulder stiffness are related to problems between the humerus and scapula. The normally supple capsule around the joint can become stiff--a condition known as frozen shoulder. Frozen shoulders can come on after a period of disuse of the arm. A frozen shoulder can also come on for no apparent reason at all. Frozen shoulders can be particularly severe in individuals with diabetes.

Shoulder stiffness can also result when the normal gliding surfaces of the shoulder become scarred after injury or surgery--a condition known as post-traumatic stiff shoulder.

The shoulder can become stiff because the joint surfaces have lost their normal smoothness--as in arthritis.

Finally, shoulder motion can be restricted by limited scapulothoracic motion (motion between the shoulder blade and the chest wall). Scapulothoracic range of motion can be limited by such factors as sternoclavicular arthritis, acromioclavicular arthritis, contracture, rib or scapular fracture, post-traumatic scarring, tumor, dislocation, or other factors disrupting the scapulothoracic motion interface.

Shoulder stiffness tends to be a chronic condition. Because of the condition's long course, the patient needs to play a major role in its treatment. We have designed a set of simple home shoulder exercises that have proven effective in improving the function of many stiff shoulders. These frequent, gentle exercises are performed at least three times a day, in a manner similar to what an athlete would use to develop more flexibility. Forceful stretching is avoided because of the risk of creating injuries to the capsule, which could then go on to heal with scar tissue.

When major functional limitations persist after six months of a first-rate effort at the home exercise program, a more aggressive approach is considered. If the persistent stiffness is due to a classical frozen shoulder, we consider an examination under anesthesia with gentle manipulation (unless the bone appears soft on X-ray).

Manipulation is not used in post-traumatic or post-surgical stiff shoulders because the scar tissue which may be stronger than the rotator cuff or bone. If examination under anesthesia is not successful, open surgical release can be considered. If the X-rays reveal a damaged joint surface, management of the glenohumeral roughness may deserve consideration.