Orthopaedics and Rehab

Unraveling the mystery – and misery – of frozen shoulder

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frozen shoulder blue
The phenomenon of frozen shoulder was first noted in a medical text book in 1872. The condition, which goes by the clinical name adhesive capsulitis, can develop overnight but exactly why still remains a mystery.

One day you’re fine, and the next you struck by excruciating shoulder pain – the kind that takes your breath away. Then comes the first of many sleepless nights.

Welcome to mysterious and miserable world of frozen shoulder.

The clinical name for frozen shoulder is adhesive capsulitis, and the condition can literally develop overnight. The lining (capsule) of the shoulder becomes inflamed and stiff, causing shooting pain with certain arm movements. Eventually, the shoulder “freezes” or becomes immobile for a few months to a year or longer.

I’ve had frozen shoulder myself, so I know how much it hurts. And I empathize with patients who try to trace the pain to a particular physical activity they should avoid in the future. That was the case for my patient, Tim Rogers, editor of D Magazine, in late spring 2019. Tim was fairly certain he’d developed a sports injury. I had to tell him, “Sorry, but no.”

Frozen shoulder is one of those spontaneous conditions we face as we age. Recovery can be long and grueling if you go it alone, which too many people do. Early intervention from a shoulder expert can get you back on track faster.

Like many patients, Tim was going to try to “tough it out.” No one likes going to the doctor, and I understand that. But take it from Tim – waiting too long isn’t worth it. In his June Editor’s Note for D Magazine, Tim wrote about “the mystery of his frozen shoulder.” He also told us about his experience with the perplexing condition. What follows are excerpts from his interview with us: 

Tim’s story: The misery of frozen shoulder

I’ve been on this planet for 49 years and I’ve never had an injury like this. My disc issues and tarsal tunnel don’t hold a candle to this misery. But the way I see it, you can’t make it this long in life without having something weird happen to your body.

And frozen shoulder is definitely weird.

I literally woke up one day with this pain that I couldn’t explain. Had I hurt my back playing golf? Was I practicing poor ergonomics at my desk? Nothing added up.

For three months, I muddled through. Honestly, I probably could have dealt with the pain if it wasn’t keeping me awake all night, every night. I felt like a zombie – a grouchy, half-awake version of myself. I had a short fuse with my family and I was unproductive at work.

One day my boss at D (the Dallas city magazine), asked me directly: “What’s going on with you?” I confessed I hadn’t been sleeping and poured out the agony of my mysterious shoulder ailment.

Instead of showering me with sympathy, he shrugged and said, “Sounds like frozen shoulder.” He’d had it, too, and now he’s fine.

WHAT?!? I’d been struggling all this time with something that can be treated? I summoned my courage and tapped into my network of friends to find the best shoulder doctor in town.

Michael Khazzam, M.D., at UT Southwestern was at the top of the list. While I was eager to get answers, I was getting nervous as my appointment drew closer. I’ve never had surgery, and I was worried he might tell me I’d have to go under the knife and then be laid up for weeks. 

"At night, as you try to rest, the lining of the shoulder tightens up like a T-shirt that’s too small. So, any little motion will cause pain and keep you awake. That’s why I hadn’t been sleeping, Dr. Khazzam explained."

Tim Rogers, editor of D Magazine

Actually, quite the opposite happened. Dr. Khazzam put me through a few diagnostic movements, like reaching behind my back and up toward my shoulder. Let me tell you – the bursts of pain brought tears to my eyes. But within five minutes, he diagnosed me with frozen shoulder just by watching my responses.

Dr. Khazzam said it was a good thing I’d come in during the inflammatory phase, before the shoulder froze up. I was relieved when he said I wouldn’t need surgery and, better yet, I could and should keep playing golf. Keeping the shoulder moving would help with recovery, he said. Being sedentary is the worst thing for frozen shoulder.

That’s why I hadn’t been sleeping, Dr. Khazzam explained. At night, as you try to rest, the lining of the shoulder tightens up like a T-shirt that’s too small. So, any little motion will cause pain and keep you awake.

Dr. Khazzam recommended an anti-inflammatory injection and regular physical therapy, which I attended for two months. The PTs used electrical stimulation to loosen up my shoulder and taught me exercises I could do at home to improve my range of motion.

Within a month, these therapies began to ease the pain. But the best part? I finally started to get some sleep. I used an ice pack and ibuprofen regimen the first couple weeks, which helped take the edge off.

When I first saw Dr. Khazzam, I asked if perhaps I’d hurt my shoulder exercising, but he said frozen shoulder is just a mysterious complication of aging. That stung a bit.

But if you find yourself trapped in the world of frozen shoulder, don’t wait until you’re desperate, like I did. It started affecting my personal and professional life. Go to the doctor right away, if only to get some peace of mind about what’s wrong. And to finally get a good night’s sleep. 

The cold, hard facts about frozen shoulder

Tim’s personal medical mystery was solved, but in a larger sense, the condition itself is still a puzzle. While we don’t know exactly why frozen shoulder develops – the condition was first noted in a medical textbook in 1872 – we know patients with thyroid problems and uncontrolled diabetes are more prone to the condition and have a tougher time recovering. Patients who have been in a sling or have been sedentary due to an accident or surgery also can develop frozen shoulder.

Rehabilitation
Frozen shoulder can affect any adult, but it is most common in people ages 40 to 60. The majority of patients recover without surgery.

Most patients are women between the ages of 40 and 60, though frozen shoulder can affect any adult. We see several cases a week, though there are no national statistics on how many people develop frozen shoulder annually. Not everyone seeks care, and unfortunately, some patients who do get misdiagnosed.

For instance, we often see patients who’ve been told they have arthritis or a rotator cuff issue. With good intentions, their doctors recommend physical therapy tailored for these conditions. At best, those specific exercises won’t be effective for frozen shoulder; at worst, certain movements can feel like torture.

Recovery can be a long road. Tim was wise to come in during the inflammatory phase. Once a shoulder is frozen, “thawing” it, or rendering it mobile again, will take much longer.

Patients like Tim who see a shoulder specialist early can recover in months as opposed to a year or longer without intervention. Eventually, frozen shoulder will resolve on its own, but that’s a long time to deal with intermittent pain, mobility issues, and sleep disruption.

Most patients recover with nonsurgical therapies. For severely frozen shoulder or patients who are fed up with the pain, we can do arthroscopic surgery. The surgeon looks inside the joint, releases the shoulder capsule, and restores your range of motion. However, you’ll still need physical therapy to regain full shoulder mobility.  

If you struggle with shoulder pain that disrupts your daily life, or if you’re not seeing results from current treatment, come see our orthopedic team and specialized physical therapists. Our doctors look beyond “cookie-cutter” diagnoses for patients like Tim, and our PTs have advanced training in shoulder rehabilitation.

At UT Southwestern, frozen shoulder is not mysterious at all. You can request an appointment online or call 214-645-8300.

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