Frozen shoulder is a debilitating condition marked by shoulder pain, stiffness and gradual loss of mobility. Little is understood about its causes, and treatment is usually limited to pain medication, physical therapy and corticosteroids. Some patients are simply told to wait until their condition improves over months or years. But thanks to several novel and minimally invasive procedures, patients can now get relief much sooner.
What Is Frozen Shoulder?
Frozen shoulder, medically known as adhesive capsulitis, is an inflammatory condition characterized by pain, stiffness and loss of motion in the shoulder. It often resolves on its own over time but can sometimes become chronic and disabling.
The American Academy of Orthopedic Surgeons defines frozen shoulder as “a condition of varying severity characterized by the gradual development of global limitation of active and passive shoulder motion where radiographic findings other than osteopenia are absent.”
Loss of active shoulder motion means you cannot move your shoulder freely, while a passive loss means your shoulder cannot be moved with an outside force, like gravity or someone stretching you.
The condition is relatively common, affecting two to five percent of the general population. It usually starts after age 55, and women are more often diagnosed.
What Causes Frozen Shoulder?
The exact causes of this condition are unknown, but physicians have identified certain risk factors that can make a person prone to developing frozen shoulder. Based on these known risk factors, the disease is classified as:
Primary adhesive capsulitis
This type has a subtle and gradual onset, usually arising spontaneously. It is often found in people with other conditions, notably diabetes mellitus, type I diabetes, thyroid disease, many autoimmune disorders and heart disease.
Secondary adhesive capsulitis
This type develops after an injury or trauma to the shoulder. Common injuries that can lead to frozen shoulder include fractures, surgery, rotator cuff tears and immobilization.
Researchers believe the condition results from inflammation and abnormal scar formation. Initially, there is inflammation within the shoulder joint that causes pain. The body then reacts to this inflammation by forming scar tissue, which causes stiffening of the shoulder joint.
Frozen Shoulder Symptoms
Your doctor can diagnose you with frozen shoulder based on symptoms alone. These symptoms are fairly specific, occur in phases and include the following:
Phase 1: Pain
Patients usually report sudden onset of diffuse shoulder pain that gets worse with time. In the beginning, the pain is worse at night and with movement, but it then becomes noticeable even during rest. This phase lasts two to nine months.
Phase 2: Freezing
As the pain slowly dwindles, the symptoms of shoulder “freezing” gradually worsen. Patients start to notice they are less and less able to move their shoulders in all directions. Daily activities can become more difficult to carry out as time goes on. This phase usually lasts four to 12 months.
Phase 3: Thawing
Also called the recovery phase, patients may notice a gradual return of their range of motion. Most patients notice a complete return of their strength and range of motion, although symptoms do not fully resolve in some. This phase usually lasts 12 to 24 months. The pain due to frozen shoulder is usually dull and aching, while the stiffness is so severe that simple arm movements become impossible.
Diagnosis and Treatment
Frozen shoulder can be diagnosed by looking at signs, symptoms and patient history.
To diagnose frozen shoulder, physicians ask the patient to try and move their arms from both shoulders in different directions. They will also try to move the patient's arms. Usually, pain and stiffness prevent a full physical exam, and the limited mobility is the same with active and passive motion. The most limited movement is the external rotation of the affected shoulder.
Patients usually don’t need to undergo laboratory or imaging testing. To rule out other conditions when necessary, doctors may refer patients to a shoulder x-ray or similar tests.
In most cases, the condition spontaneously resolves on its own after 18 to 30 months. In that time, treatment is mainly focused on easing symptoms and includes NSAIDs, physical therapy, oral corticosteroids and surgery for recurring cases.
How We Treat Frozen Shoulder
At Vascular and Interventional Partners in Scottsdale, AZ, patients who do not find relief with conservative treatment can be treated with a minimally invasive procedure called frozen shoulder embolization.
Frozen shoulder embolization works by blocking abnormal blood vessels that are behind the pain and stiffness of frozen shoulder. Imaging studies show that frozen shoulders are highly vascularized. This excess of abnormally large blood vessels allows pro-inflammatory mediators to enter the tissue and cause abnormal scarring and inflammation.
Embolization procedures, which are already performed to treat many other conditions, are now seen as a promising solution for frozen shoulder. By blocking abnormal blood vessels, inflammation subsides and scar formation is reduced. As a result, patients feel less pain and achieve a greater range of motion.
Benefits of Frozen Shoulder Embolization
If you have tried conservative approaches but have failed to find relief or your condition recurs, there are many benefits to frozen shoulder embolization:
- Minimally invasive outpatient procedure
- Performed under local anesthesia with minimal scarring
- Suitable for most patients, even with chronic health conditions
- Symptom improvement in 80 to 85 percent of all cases
- Safe with very few side effects
- Recovery takes place within a couple of days
- May be covered by insurance in some cases
Why Choose Vascular and Interventional Partners?
For embolization procedures to provide promised results with no serious side effects, they must be performed by experienced and skilled specialists. This is also true for frozen shoulder embolization, where doctors must carefully target the abnormal blood vessels behind frozen shoulder while preserving the health and integrity of surrounding structures.
The doctors at Vascular and Interventional Partners are experienced in a wide range of embolization procedures, including frozen shoulder embolization. We have performed this procedure on countless Arizona patients with outstanding outcomes. If you are interested in scheduling this treatment with Arizona’s leading interventional radiology division, contact us or call us today at (480) 435-9100.