Public release date: 7-Sep-2011
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Contact: Kayee Ip
ip@aaos.org
847-384-4035
American Academy of Orthopaedic Surgeons

When that shoulder aches too much to move

Treatment options for stiff and painful shoulders caused by adhesive capsulitis

Adhesive capsulitis, sometimes described as "frozen shoulder," is a condition where the connective tissue around the shoulder joint becomes chronically inflamed, causing thickening and tightening in the affected joint. Diagnosing adhesive capsulitis can be difficult because its symptoms—restricted movement and considerable pain—are similar to a variety of shoulder-related musculoskeletal conditions, including arthritis. Proper diagnosis of adhesive capsulitis may require extensive investigation into the patient's medical history to eliminate other causes.

According to a recent literature review published in the Journal of the American Academy of Orthopaedic Surgeons (JAAOS), "patients with a painful stiff shoulder are frequently diagnosed with frozen shoulder" which is a vague diagnosis because there are many factors that contribute to motion loss in the shoulder, says Robert J. Neviaser, MD, Professor and Chairman of the Department of Orthopaedic Surgery at George Washington University Medical Center in Washington, D.C., who co-authored the review with his son, Andrew S. Neviaser, MD, Assistant Professor in the department.

Adhesive capsulitis is not necessarily the result of an injury. The condition can start out as some soreness in the shoulder before the patient begins to notice some progressive restriction of movement.

Common adhesive capsulitis symptoms include:

• Night pain, and patients typically cannot sleep on the affected side.
• Restricted movement to the extent that patients tend to have difficulty dressing, combing their hair, or reaching into a back pocket.
• Many patients have minimal or no pain once the shoulder gets fairly restrictive in motion, but will notice pain when suddenly reaching beyond the limits of the stiffness.

Populations most at-risk:

• Women between ages 40 and 60 are most prone to develop adhesive capsulitis.
• People with diabetes have an increased risk of developing the condition.
• Persons with less physically active occupations than in persons who perform manual labor—usually the non-dominant shoulder is the one involved.

Managing pain/restoring shoulder movement:
The best way to help restore the patient's range of movement and significantly reduce shoulder discomfort begins with gentle, progressive stretching exercises over weeks, sometimes months, in order to relieve adhesive capsulitis symptoms.

"The first step in treatment is a physical therapy program to stretch the capsule slowly and progressively. This is usually successful. We limit surgical interventions to patients who do not show adequate progress over a period of months of physical therapy, and are still significantly restricted in their movement and function in daily life. If surgery is required, arthroscopic capsular release—removal of the thickened and scarred capsule—has shown improved pain relief and restoration of shoulder function two to five years after the surgery, but while successful, surgery is rarely needed," said Dr. Neviaser.

Notes on diagnosis:
According to Dr. Neviaser, "As a result of an inflammatory process, the joint lining develops scarring which becomes a restraint to movement—like a tether. And within the limits of what that restraint or tether allows, the person is usually uncomfortable, but they can function. If they suddenly reach beyond that, without thinking—such as going to reach for something—then they develop a sharp, severe pain, because what they're doing, effectively, is microscopic tearing of the scar tissue."

"Probably the only condition that is similar during the physical examination is shoulder-joint arthritis," said Dr. Neviaser. "But with shoulder-joint arthritis, when you try to move the shoulder, you often get a ratchety, grinding sensation—which you do not get with adhesive capsulitis, and of course, the x-rays will show the arthritic changes." While MRIs and other imaging tests can be valuable in excluding other causes of the symptoms, they are not generally required for diagnosis.

Adhesive capsulitis, sometimes described as "frozen shoulder," is a condition where the connective tissue around the shoulder joint becomes chronically inflamed, causing thickening and tightening in the affected joint. Diagnosing adhesive capsulitis can be difficult because its symptoms - restricted movement and considerable pain - are similar to a variety of shoulder-related musculoskeletal conditions, including arthritis. Proper diagnosis of adhesive capsulitis may require extensive investigation into the patient's medical history to eliminate other causes.

According to a recent literature review published in the Journal of the American Academy of Orthopaedic Surgeons (JAAOS), "patients with a painful stiff shoulder are frequently diagnosed with frozen shoulder" which is a vague diagnosis because there are many factors that contribute to motion loss in the shoulder, says Robert J. Neviaser, MD, Professor and Chairman of the Department of Orthopaedic Surgery at George Washington University Medical Center in Washington, D.C., who co-authored the review with his son, Andrew S. Neviaser, MD, Assistant Professor in the department.

Adhesive capsulitis is not necessarily the result of an injury. The condition can start out as some soreness in the shoulder before the patient begins to notice some progressive restriction of movement.

Common adhesive capsulitis symptoms include:

• Night pain, and patients typically cannot sleep on the affected side.
• Restricted movement to the extent that patients tend to have difficulty dressing, combing their hair, or reaching into a back pocket.
• Many patients have minimal or no pain once the shoulder gets fairly restrictive in motion, but will notice pain when suddenly reaching beyond the limits of the stiffness.

Populations most at-risk:

• Women between ages 40 and 60 are most prone to develop adhesive capsulitis.
• People with diabetes have an increased risk of developing the condition.
• Persons with less physically active occupations than in persons who perform manual labor - usually the non-dominant shoulder is the one involved.

Managing pain/restoring shoulder movement:

The best way to help restore the patient's range of movement and significantly reduce shoulder discomfort begins with gentle, progressive stretching exercises over weeks, sometimes months, in order to relieve adhesive capsulitis symptoms.

"The first step in treatment is a physical therapy program to stretch the capsule slowly and progressively. This is usually successful. We limit surgical interventions to patients who do not show adequate progress over a period of months of physical therapy, and are still significantly restricted in their movement and function in daily life. If surgery is required, arthroscopic capsular release - removal of the thickened and scarred capsule - has shown improved pain relief and restoration of shoulder function two to five years after the surgery, but while successful, surgery is rarely needed," said Dr. Neviaser.

Notes on diagnosis:

According to Dr. Neviaser, "As a result of an inflammatory process, the joint lining develops scarring which becomes a restraint to movement - like a tether. And within the limits of what that restraint or tether allows, the person is usually uncomfortable, but they can function. If they suddenly reach beyond that, without thinking - such as going to reach for something - then they develop a sharp, severe pain, because what they're doing, effectively, is microscopic tearing of the scar tissue."

"Probably the only condition that is similar during the physical examination is shoulder-joint arthritis," said Dr. Neviaser. "But with shoulder-joint arthritis, when you try to move the shoulder, you often get a ratchety, grinding sensation - which you do not get with adhesive capsulitis, and of course, the x-rays will show the arthritic changes." While MRIs and other imaging tests can be valuable in excluding other causes of the symptoms, they are not generally required for diagnosis.

Disclosure: Neither of the following authors nor any immediate family member has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. A. Neviaser and Dr. R. Neviaser.

• Additional
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It's of a swamp house on a bayou and has a Louisiana feel to it. It's called Alligator Fisher and I'm thinking about getting because it reminds me of my cajun heritage, most of my family is from Louisiana. I don't know whose smile is bigger, the one in the painting or the one on my face every time I look at it.There is a water scene that I really like painted in 1940. I'll find someone to give it to. I personally don't have any of these in my collection, since I like to collect pieces that I can relate to.Another painting that I admire is called Howard in 1944.I have loved folk art paintings that depict the world of black Americans.One of my favorite paintings was done in 1962 by Bill Dodge. Still, they are a joy to behold. It's too bad my parents didn't let her play football with the boys and I used to tease her relentlessly and pull her pigtails whenever I got the chance.. She looked so relaxed, that I could imagine what it felt like to lie there myself. She favors animal prints, and I found one of a woman reclining in a hammock. It's a beautiful painting but it's just too depressing to hang anywhere.The painting that has touched me the most features a sad little girl and is called.....

Disclosure: Neither of the following authors nor any immediate family member has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Neviaser. Neviaser, MD, Professor and Chairman of the Department of Orthopaedic Surgery at George Washington University Medical Center in Washington, D. The condition can start out as some soreness in the shoulder before the patient begins to notice some progressive restriction of movement. Diagnosing adhesive capsulitis can be difficult because its symptoms—restricted movement and considerable pain—are similar to a variety of shoulder-related musculoskeletal conditions, including arthritis. Restricted movement to the extent that patients tend to have difficulty dressing, combing their hair, or reaching into a back pocket. Neviaser, MD, Assistant Professor in the department." "Probably the only condition that is similar during the physical examination is shoulder-joint arthritis," said Dr. Persons with less physically active occupations than in persons who perform manual labor - usually the non-dominant shoulder is the one involved. Neviaser, MD, Assistant Professor in the department." "Probably the only condition that is similar during the physical examination is shoulder-joint arthritis," said Dr. Persons with less physically active occupations than in persons who perform manual labor - usually the non-dominant shoulder is the one involved. Neviaser, MD, Assistant Professor in the department." "Probably the only condition that is similar during the physical examination is shoulder-joint arthritis," said Dr. Persons with less physically active occupations than in persons who perform manual labor - usually the non-dominant shoulder is the one involved. Neviaser, MD, Assistant Professor in the department." "Probably the only condition that is similar during the physical examination is shoulder-joint arthritis," said Dr. Persons with less physically active occupations It was painted in 1988 by Reverend Howard Finster and is done in enamel. I spent a lot of time playing in my tree house, that the trees in the picture appealed to me so much. It's called First Trolley to Van Nuys and shows the center of a town filled with people.One of the most famous American artists is Thomas Chambers.Another painting that I admire is called Howard in 1944. She looked so relaxed, that I could imagine what it felt like to lie there myself.There is a subcategory of folk art paintings that depict the world of black Americans. If she could kick the ball they way she liked to kick me in the knee, I'd see to it she played for my team every time. It's too bad my parents didn't let her play football with us. Still, they are a joy to behold. It's called Alligator Fisher and I'm thinking about getting because it reminds me of my cajun heritage, most of my family is from Louisiana. It's a beautiful painting but it's just too depressing to hang anywhere. I don't particularly care

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[ | E-mail | Share ]

Contact: Kayee Ip
ip@aaos.org
847-384-4035
American Academy of Orthopaedic Surgeons

When that shoulder aches too much to move

Treatment options for stiff and painful shoulders caused by adhesive capsulitis

Adhesive capsulitis, sometimes described as "frozen shoulder," is a condition where the connective tissue around the shoulder joint becomes chronically inflamed, causing thickening and tightening in the affected joint. Diagnosing adhesive capsulitis can be difficult because its symptoms—restricted movement and considerable pain—are similar to a variety of shoulder-related musculoskeletal conditions, including arthritis. Proper diagnosis of adhesive capsulitis may require extensive investigation into the patient's medical history to eliminate other causes.

According to a recent literature review published in the Journal of the American Academy of Orthopaedic Surgeons (JAAOS), "patients with a painful stiff shoulder are frequently diagnosed with frozen shoulder" which is a vague diagnosis because there are many factors that contribute to motion loss in the shoulder, says Robert J. Neviaser, MD, Professor and Chairman of the Department of Orthopaedic Surgery at George Washington University Medical Center in Washington, D.C., who co-authored the review with his son, Andrew S. Neviaser, MD, Assistant Professor in the department.

Adhesive capsulitis is not necessarily the result of an injury. The condition can start out as some soreness in the shoulder before the patient begins to notice some progressive restriction of movement.

Common adhesive capsulitis symptoms include:

• Night pain, and patients typically cannot sleep on the affected side.
• Restricted movement to the extent that patients tend to have difficulty dressing, combing their hair, or reaching into a back pocket.
• Many patients have minimal or no pain once the shoulder gets fairly restrictive in motion, but will notice pain when suddenly reaching beyond the limits of the stiffness.

Populations most at-risk:

• Women between ages 40 and 60 are most prone to develop adhesive capsulitis.
• People with diabetes have an increased risk of developing the condition.
• Persons with less physically active occupations than in persons who perform manual labor—usually the non-dominant shoulder is the one involved.

Managing pain/restoring shoulder movement:
The best way to help restore the patient's range of movement and significantly reduce shoulder discomfort begins with gentle, progressive stretching exercises over weeks, sometimes months, in order to relieve adhesive capsulitis symptoms.

"The first step in treatment is a physical therapy program to stretch the capsule slowly and progressively. This is usually successful. We limit surgical interventions to patients who do not show adequate progress over a period of months of physical therapy, and are still significantly restricted in their movement and function in daily life. If surgery is required, arthroscopic capsular release—removal of the thickened and scarred capsule—has shown improved pain relief and restoration of shoulder function two to five years after the surgery, but while successful, surgery is rarely needed," said Dr. Neviaser.

Notes on diagnosis:
According to Dr. Neviaser, "As a result of an inflammatory process, the joint lining develops scarring which becomes a restraint to movement—like a tether. And within the limits of what that restraint or tether allows, the person is usually uncomfortable, but they can function. If they suddenly reach beyond that, without thinking—such as going to reach for something—then they develop a sharp, severe pain, because what they're doing, effectively, is microscopic tearing of the scar tissue."

"Probably the only condition that is similar during the physical examination is shoulder-joint arthritis," said Dr. Neviaser. "But with shoulder-joint arthritis, when you try to move the shoulder, you often get a ratchety, grinding sensation—which you do not get with adhesive capsulitis, and of course, the x-rays will show the arthritic changes." While MRIs and other imaging tests can be valuable in excluding other causes of the symptoms, they are not generally required for diagnosis.

Adhesive capsulitis, sometimes described as "frozen shoulder," is a condition where the connective tissue around the shoulder joint becomes chronically inflamed, causing thickening and tightening in the affected joint. Diagnosing adhesive capsulitis can be difficult because its symptoms - restricted movement and considerable pain - are similar to a variety of shoulder-related musculoskeletal conditions, including arthritis. Proper diagnosis of adhesive capsulitis may require extensive investigation into the patient's medical history to eliminate other causes.

According to a recent literature review published in the Journal of the American Academy of Orthopaedic Surgeons (JAAOS), "patients with a painful stiff shoulder are frequently diagnosed with frozen shoulder" which is a vague diagnosis because there are many factors that contribute to motion loss in the shoulder, says Robert J. Neviaser, MD, Professor and Chairman of the Department of Orthopaedic Surgery at George Washington University Medical Center in Washington, D.C., who co-authored the review with his son, Andrew S. Neviaser, MD, Assistant Professor in the department.

Adhesive capsulitis is not necessarily the result of an injury. The condition can start out as some soreness in the shoulder before the patient begins to notice some progressive restriction of movement.

Common adhesive capsulitis symptoms include:

• Night pain, and patients typically cannot sleep on the affected side.
• Restricted movement to the extent that patients tend to have difficulty dressing, combing their hair, or reaching into a back pocket.
• Many patients have minimal or no pain once the shoulder gets fairly restrictive in motion, but will notice pain when suddenly reaching beyond the limits of the stiffness.

Populations most at-risk:

• Women between ages 40 and 60 are most prone to develop adhesive capsulitis.
• People with diabetes have an increased risk of developing the condition.
• Persons with less physically active occupations than in persons who perform manual labor - usually the non-dominant shoulder is the one involved.

Managing pain/restoring shoulder movement:

The best way to help restore the patient's range of movement and significantly reduce shoulder discomfort begins with gentle, progressive stretching exercises over weeks, sometimes months, in order to relieve adhesive capsulitis symptoms.

"The first step in treatment is a physical therapy program to stretch the capsule slowly and progressively. This is usually successful. We limit surgical interventions to patients who do not show adequate progress over a period of months of physical therapy, and are still significantly restricted in their movement and function in daily life. If surgery is required, arthroscopic capsular release - removal of the thickened and scarred capsule - has shown improved pain relief and restoration of shoulder function two to five years after the surgery, but while successful, surgery is rarely needed," said Dr. Neviaser.

Notes on diagnosis:

According to Dr. Neviaser, "As a result of an inflammatory process, the joint lining develops scarring which becomes a restraint to movement - like a tether. And within the limits of what that restraint or tether allows, the person is usually uncomfortable, but they can function. If they suddenly reach beyond that, without thinking - such as going to reach for something - then they develop a sharp, severe pain, because what they're doing, effectively, is microscopic tearing of the scar tissue."

"Probably the only condition that is similar during the physical examination is shoulder-joint arthritis," said Dr. Neviaser. "But with shoulder-joint arthritis, when you try to move the shoulder, you often get a ratchety, grinding sensation - which you do not get with adhesive capsulitis, and of course, the x-rays will show the arthritic changes." While MRIs and other imaging tests can be valuable in excluding other causes of the symptoms, they are not generally required for diagnosis.

Disclosure: Neither of the following authors nor any immediate family member has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. A. Neviaser and Dr. R. Neviaser.

• Additional
• References
• Citations