The hallmark of the frozen shoulder is the stiffness. The pain is almost imperceptible at first, but gradually the dullness and the ache in the shoulder grows over a period of months, sometimes to the point where it may become some of the worst pain you have ever faced. Eventually, moving your shoulder at all becomes nearly impossible and you start waging a silent war just to get through the normal motions of the day.
In the medical world, it’s called adhesive capsulitis. To the layman, it’s known as a frozen shoulder - the condition you develop when the connective tissue surrounding the shoulder joint becomes thick, stiff, and inflamed.
Although it is not an uncommon condition, the onset of the frozen shoulder syndrome is shrouded in a bit of mystery for a significant group of patients. For many patients who walk into Dr. John L. Todd’s office at Baldwin Bone and Joint presenting with frozen shoulder pain, the condition seems to come out of nowhere. The onset is a surprise, but the demographic of the patient is almost completely predictable. Virtually always female, she’ll be a tall and slender Caucasian woman between the ages of 35 to 60 with fair hair, fair eyes, and fair skin. She’s almost never African American, though occasionally Asian.
“There is a genetic phenotype that is predisposed to this condition,” said Dr. Todd.
For this group of patients, the medical community believes that frozen shoulder is sparked by a minor inflammation that they might have developed from carrying out even mundane tasks like washing their car, raking the leaves, or painting the kitchen. But instead of going away the next day after they sleep on it, the inflammation crescendos and eventually turns into an immobile shoulder that spurs patients to see a physician.
A second type of patient also walks into Dr. Todd’s office with the glaring symptoms of frozen shoulder. For these patients, the pain and stiffness doesn’t manifest for no apparent reason. They’ve had a memorable event such as a fall that has immobilized their shoulder. Some of them might have undergone an open-heart surgery where their arms were spread wide on a table – putting the shoulder in an awkward and uncomfortable position. Or maybe it was a stroke that primarily affected one side of the body and led to the development of a frozen shoulder on that side. Physicians also know that metabolic diseases like thyroid disease or diabetes can increase the chances of developing a frozen shoulder.
No matter which type of patient it is, Dr. Todd at The Shoulder Center at Baldwin Bone and Joint takes the same approach to treating a frozen shoulder. When it’s in the early and most painful stages, patients will be given supportive care (a sling) and an oral non-steroidal anti-inflammatory, a cortisone injection in the shoulder joint, and referral to physical therapy. Many people will find relief with this type of conservative treatment for frozen shoulder. Those that don’t recover are candidates for manipulation under anesthesia---stretching the shoulder to tear the scar tissue that has formed (another hallmark of the condition) while the patient is asleep. This type of surgery is followed by a minimally invasive arthroscopy, which allows Dr. Todd to place a scope and other tools into the joint to see inside the shoulder and clean out the debris of the scar tissue.
The good news is that many patients find relief and recovery with conservative care and/or the surgeries described above.
“The frozen shoulder is one of the most painful shoulder conditions, characterized by progressive loss of motion over months with associated pain,” Dr. Todd explained. “Unfortunately for those who develop idiopathic adhesive capsulitis – the type that comes out of nowhere – they still have the risk of developing it again in the future, sometimes in the opposite shoulder, because we haven’t changed the predisposition.”
Dr. John L. Todd is a fellowship trained orthopedic surgeon and expert on the shoulder at Baldwin Bone and Joint. If you are experiencing shoulder pain or stiffness, set up an appointment with Dr. John L. Todd at The Shoulder Center at Baldwin Bone and Joint. Call (251) 625-2663 for your consultation.