Frozen Shoulder (Adhesive Capsulitis)
Frozen shoulder involves constant severe limitation of the range of motion of the shoulder due to scarring around the shoulder joint (adhesive capsulitis). Frozen shoulder is an unwanted consequence of rotator cuff disease: damage to the rotator cuff, the set of four tendons that stabilize the shoulder joint and help move the shoulder in diverse directions. Rotator cuff disease can be due to trauma, inflammation or degeneration. The common symptom is pain in the shoulder of gradual or sudden onset, typically located to the front and side of the shoulder, increasing when the arm is moved away from the body. A person with severe tears in the rotator cuff tendons may not be able to hold that arm up. An example of this is Senator John McCain who sustained war injuries. In public you will notice that he never raises his right hand above shoulder level. The diagnosis of rotator cuff disease can be confirmed by x-ray, an arthrogram (in which contrast dye is injected into the shoulder joint) or, less invasively, by MRI. Treatment depends on the severity of the injury to the rotator cuff. Mild rotator cuff damage is treated with ice, rest, and anti-inflammatory medications (such as ibuprofen) and, if needed, a cortisone injection in the rotator cuff. (However, although this gives temporary relief, repeated injections worsen the condition.) More severe rotator cuff disease may require arthroscopic or open surgical repair. Gradual exercises are important and are specifically designed to strengthen the rotator cuff and increase its range of motion. Alternative treatment, and often successful, is prolotherapy which helps the damaged tendons regenerate.