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Frozen Shoulder: Movement is important after surgery

Jamie

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Your shoulder is a ball-and-socket joint made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle). The head of the upper arm bone fits into a shallow socket in your shoulder blade called the glenoid. Strong connective tissue, called the shoulder capsule, surrounds the joint. To help your shoulder move more easily, synovial fluid lubricates the shoulder capsule and the joint.

shoulder 1.jpg


The illustration above shows the shoulder capsule and how it's position surrounds the shoulder joint and tendons of the rotator cuff (the shoulder muscles).

Having shoulder surgery makes you more likely to develop a frozen shoulder (also called adhesive capsulitis) if the joint is not moved on a regular basis. But it can also appear in people who have not had surgery. As it develops, the shoulder capsule thickens and becomes stiff and tight. Thick bands of tissue called adhesions develop. In many cases, there is less synovial fluid in the joint, which increases stiffness in the joint. The hallmark signs of this condition are severe pain and being unable to move your shoulder -- either on your own or with the help of someone else. It develops in three stages:

Stage 1: Freezing
In the "freezing" stage, you slowly have more and more pain. As the pain worsens, your shoulder loses range of motion. Freezing typically lasts from 6 weeks to 9 months.

Stage 2: Frozen
Painful symptoms may actually improve during this stage, but the stiffness remains. During the 4 to 6 months of the "frozen" stage, daily activities may be very difficult.

Stage 3: Thawing
Shoulder motion slowly improves during the "thawing" stage. Complete return to normal or close to normal strength and motion typically can take from 6 months to 3 years.

shoulder.JPG


The causes of frozen shoulder are not fully understood. A few factors may put you more at risk for developing frozen shoulder such as diabetes or other medical problems such as hypothyroidism, hyperthyroidism, Parkinson's disease, and cardiac disease. Women tend to develop the condition more often than men.

But for our purposes here on BoneSmart, a frozen shoulder can occur during periods of immobilization after shoulder surgery. All patients will be advised to move their shoulders soon after surgery and on a regular basis throughout their recovery.

Pain from frozen shoulder is usually dull or aching. It is typically worse early in the course of the disease and when you move your arm. The pain is usually located over the outer shoulder area and sometimes the upper arm.

Frozen shoulder can improve with non-surgical treatment, but it can take a very long time in some cases. There are also treatment options that include a manipulation under anesthetic or surgery to improve movement, but these options are usually only offered after other, non-invasive treatments have failed.

The bottom line is, it's important to maintain movement in your shoulder after any type of surgery to prevent a frozen shoulder from occurring. Depending on the type of surgery you've had, your surgeon may recommend active or passive exercises for a period of weeks to months.
 

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