While the term “frozen shoulder” likely conjures up a casual description of how your shoulders feel when over-exposed to winter temperatures – or giving someone the proverbial “cold shoulder” – there really is a medical condition known by that name. Marked by shoulder pain and limited range of motion, it is estimated to affect up to 3% to 5% of the population. In addition, Orthopedists are seeing and hearing about an increase in frozen shoulder among patients who have had COVID-19, so the incidences of this condition may be on the rise.
Let’s take a look at what it is and how to treat it.
What is frozen shoulder and how do you know if you have it?
Frozen shoulder, known medically as adhesive capsulitis of the shoulder, is a condition in which there is chronic inflammation of the deep inner lining (i.e. the capsule) of the shoulder joint, with subsequent fibrosis (or scarring) of this inner lining. Typically, it starts off with nonspecific pain, and then develops into worsening stiffness and decreased range of motion. My frozen shoulder patients experience difficulty with sports, household chores, and even simple tasks such as getting dressed – especially putting on a coat, which is especially challenging during the winter.
There is no specific test for frozen shoulder, which can make it tricky to identify. Instead, it’s typically diagnosed by considering these three factors:
- Patient history: description of a patient’s symptoms and, occasionally, how those symptoms relate to a pre-symptom injury
- Physical examination
- Tests that rule out other problems/diagnoses: for example, X-rays that do not show arthritis, or MRIs that do not show tears
What causes frozen shoulder?
In most cases, there is no known cause. Predisposing factors include autoimmune or endocrine conditions, such as diabetes mellitus, thyroid conditions, or other rheumatologic conditions. Frozen shoulder can also be triggered by a minor injury or sprain or, in the case of what’s known as secondary frozen shoulder, can be due to inciting factors such as a prior shoulder injury or surgery or a neurologic condition.
What is the link between frozen shoulder and COVID?
It’s important to note that we do not yet have evidence to confirm a direct cause-and-effect relationship, but many in the orthopedic community have speculated that COVID-19 infection could likely exacerbate frozen shoulder, especially given both of their immunologic mechanisms. People who have had COVID-19 frequently experience an inflammatory response to the virus, which can trigger symptoms in any organ or system, including the musculoskeletal system – as well as the joints within. The link between COVID-19 and frozen shoulder, therefore, is based on reports that the inflammatory reaction in frozen shoulder shows several similarities to that in COVID-19 and that the cells in the lining of the shoulder joint may be targeted by the virus.
Also, the secondary effects of the pandemic have included significant changes in lifestyle for many, including a decrease in physical activity, which can also bring on or exacerbate frozen shoulder.
How is frozen shoulder treated?
For most patients, frozen shoulder is effectively managed with a combination of non-operative treatments, including:
- Specific and targeted physical therapy
- Daily home exercise program as directed by a physical therapist
- Short-term NSAID medications (ibuprofen, aspirin, etc.)
- Cortisone injections
For those patients who do not sufficiently improve with this approach – which happens about 10-15% of the time – we typically perform a minimally invasive surgery, known as shoulder arthroscopy, followed by additional physical therapy. This approach is often quite successful and has greatly lessened the time to heal for many patients.
How long does it take for frozen shoulder to heal?
With a mild case, patients will start to feel better typically in one to two months, while moderate cases can sometimes take three to six months. Unfortunately, without any treatment, an advanced case of frozen shoulder can really linger, sometimes for up to three years.
While frozen shoulder may sound scary or intimidating, it is a condition we are routinely able to treat effectively. By spending a sufficient amount of time in the office with a patient reviewing their symptoms, history and other factors, and implementing the above diagnostic and treatment concepts, I have been able to achieve optimal outcomes for many patients.