Vanderbilt Sports Medicine (VSM)
Knee Center and Shoulder Center
Vanderbilt Sports Medicine is a unique center within the
Vanderbilt Orthopaedic Institute (VOI). We pride ourselves on
using a ‘team’ approach to patient care. The ‘team’ is made
up of sports medicine doctors, physical therapists and athletic
trainers, many of whom are experts in the field of sports
medicine.
All of the rehabilitation staff have passed a certification exam
in physical therapy and/or athletic training and are licensed
healthcare professionals. All of the doctors have had at least one
year of extra training in sports medicine.
Using the concepts of evidence-based medicine, everyone
works together to give you the best possible care. Evidence-
based medicine takes into account three equally important
factors: your needs and wishes, the doctor’s knowledge and
skill, and the best research available.
Our core purpose at Vanderbilt Sports
Medicine is to improve the lives of our
patients through excellence in research,
education and patient care.
Table of Contents
The Shoulder Joint . . . . . . . . . . . . . . . . . . . . . . 1
What is Frozen Shoulder? . . . . . . . . . . . . . . . . 2
Who Gets Frozen Shoulder? . . . . . . . . . . . . . . 3
What are the Signs and Symptoms? . . . . . . . . 4
How Can My Doctor Tell if I Have Frozen
Shoulder? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
How is it Treated? . . . . . . . . . . . . . . . . . . . . .5-7
Frequently Asked Questions . . . . . . . . . . . . . . 8
For more information about frozen shoulder:
American Academy of Orthopaedic Surgeons:
http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID =162&
topcategory=Shoulder
Copyright 2010 - Vanderbilt Sports Medicine
8 1
The Shoulder Joint
The shoulder joint is made of the humeral head and the
glenoid. The humeral head rests on the glenoid like a golf ball on
a tee.
The joint capsule
is in a sac that covers or
surrounds the shoulder
joint. In normal
shoulders, the joint
capsule has some
looseness which
allows the shoulder to
have full range of
motion.
In a frozen
shoulder, the normal
looseness in the capsule is lost because of the inflammation and
scarring. This causes the shoulder to get stiff.
Frequently Asked Questions
1. Why did I get a Frozen Shoulder?
Many times the cause of frozen shoulder is not known. It
may be related to your diabetes or an injury/surgery of your
shoulder, elbow or wrist. Many times though it starts with no
injury or warning.
2. How long do I have to go to therapy?
The length of therapy varies from patient to patient. It
usually starts in Stage 2 with you going to formal therapy three
times a week. As your pain decreases and your motion starts
to increase your doctor may switch you to a home exercise
program. All in all you may have to do some form of therapy
for several weeks or months.
3. Will I get all of my motion back?
Some patients regain full motion back but other patients
may only get partial motion back. Even if you don’t get your full
motion back, the amount of motion lost does not seem to get
in the way of normal daily activities. In other words, you can
usually do your daily activities without any problems.
4. How can I prevent it from happening to my other
shoulder?
Some patients will get a frozen shoulder in their other
shoulder. It usually occurs within five years, after the first
shoulder has gotten better but again we are not sure why.
If you have an injury to your shoulder or if it starts to
hurt after doing some sort of activity (such as raking leaves or
painting or moving furniture) make an appointment with your
doctor if it doesn’t get better within a couple of days. Do not
wait until you can no longer take the pain or cannot move your
shoulder.
5. Is it normal for my shoulder to hurt so much at
night?
Yes. Many patients with shoulder problems, especially frozen
shoulder, have pain at night and trouble sleeping. Some things
that may help are sleeping more upright, like in a recliner or
propped up on pillows. You may also ask your doctor about
medicine to help you sleep.
Copyright 2010 - Vanderbilt Sports Medicine
2 7
What is Frozen Shoulder?
Frozen Shoulder, also called Adhesive Capsulitis, causes pain
and stiffness in the shoulder, which can be very severe at times.
With a frozen shoulder the capsule around the shoulder joint
gets thick and scarred (see pictures on page 1), and this limits
the normal motion of the shoulder.
It can be very frustrating for patients because most of the
time the doctors don’t know why it happens and can’t say exactly
how long it will last.
• Pain may start instantly or it may start slowly.
• Stiffness often starts slowly and gets worse with time.
• At times it may be very hard or even impossible to do
simple things like comb your hair or reach in your back
pocket.
• Symptoms may last for up to one year and sometimes
longer.
• Symptoms may go away instantly.
Patients with a frozen shoulder often go through three
stages:
Stage 1: The Painful Stage
Stage 2: The Stiffening or Frozen Stage
Stage 3: The Thawing Stage
Manipulation Under Anesthesia
• While you are under anesthesia your doctor moves your
shoulder in different directions to break up the scar
tissue. Your doctor may do this alone or in addition to
surgery.
Surgery (Arthroscopy, Capsular Release)
• Your doctor uses a camera to look inside your shoulder
and then cuts the scar tissue away. During the surgery,
your doctor will make two small incisions (or cuts) - one
for the camera (arthroscope) and the other one for the
tool(s) needed during surgery. After your doctor cuts the
scar tissue during the arthroscopy, he/she may also do a
manipulation under anesthesia.
Sometimes even though you work hard, you
may not get enough of your motion back.
If this happens and your symptoms have been
going on for many months, your doctor may
suggest surgery and/or a manipulation under
anesthesia.
Copyright 2010 - Vanderbilt Sports Medicine
36
Who Gets Frozen Shoulder?
• More common in patients 40 to 60 years old
• Slightly more common in women
• Usually affects one shoulder at a time
• Affects non-dominant shoulder slightly more (In other
words, in right-handed patients, the left shoulder is
affected a little bit more often.)
What are some other risk factors for
getting a frozen shoulder?
Many times we never know what causes a frozen shoulder. It
does seem to be more common with certain conditions such as:
• Shoulder injury or surgery: After surgery, an injury, or
overuse (such as painting or working in the garden) you
may have some pain so you favor your shoulder; in other
words, you do not use it normally. The longer you favor
your shoulder, the stiffer it gets.
• A wrist or elbow injury: It may also happen after a wrist
or elbow injury because again you are not using your arm
normally.
• Diabetes: About 1 to 3 out of every 10 people with
diabetes will get a frozen shoulder at some point. High
sugar levels may affect the tissue that makes up the
capsule but we are not sure.
• Other medical problems: Such as heart disease/heart
surgery, thyroid disease and Parkinson’s disease
Stage 2: The Stiffening or Frozen Stage
• When your pain at rest is gone your doctor will send you
to physical therapy to start working on your motion.
• Again your doctor may suggest giving you a steroid
injection (shot) to help decrease the pain.
Stage 3: The Thawing Stage
• Your doctor will continue your therapy. The therapist
or athletic trainer working with you may start to use
different machines or exercises to help increase motion
and to help make the shoulder stronger.
• You will be switched to a home exercise program. The
therapist or athletic trainer will show you what exercises
to do at home and will tell you how many times a day or
week you should do them.
Goal: To start increasing your motion
Goal: To keep increasing your motion
Copyright 2010 - Vanderbilt Sports Medicine
54
What are the Signs and Symptoms?
Stage 1: The Painful Stage
• Achy, dull pain at rest
• Sharp pain at extremes of motion. In other words, when
you move your arm as far as you can in one direction.
• Pain may be worse at night
• As the pain worsens, the shoulder starts to get stiff
• May last from 6 weeks to 9 months
Stage 2: The Stiffening or Frozen Stage
• Pain slowly gets better
• Pain mainly at extremes of motion. In other words, when
you move your arm as far as you can in one direction.
• Stiffness is the biggest problem
• May last from 4 months to 9 months
Stage 3: The Thawing Stage
• Stiffness slowly starts getting better
• May last from 5 months to about 2 years
Key Point: Pain at Rest
Key Point: Stiffness is the biggest problem
Key Point: Pain at Rest
How Can My Doctor Tell If I Have
Frozen Shoulder?
Your doctor can tell you have a frozen shoulder by getting a
good history and doing a good physical exam.
X-rays or an MRI are not needed to make the diagnosis of
frozen shoulder. Sometimes your doctor may get an x-ray or
an MRI to make sure something else isn’t causing your pain or
symptoms.
How is it Treated?
Treatment depends on the stage of the disease. Most patients
will get better with medicine, therapy and sometimes a steroid
injection (or shot).
Stage 1: The Painful Stage
•
You may use your arm in pain-free motions – If it hurts,
don’t do it.
• Your doctor may suggest an anti-inflammatory medicine
(such as Aleve or Naprosyn) to help with the pain and
inflammation.
• Your doctor may suggest giving you a steroid injection
(shot) in your shoulder to help with the pain and
inflammation.
Note: If you have diabetes, a steroid shot may increase your
blood sugar. You should check your sugar closely for 1 - 2 days
after the shot.
• Your doctor may send you to physical therapy or may
suggest some home exercises, depending on the amount
of pain you are having.
Goal: To reduce your pain
Copyright 2010 - Vanderbilt Sports Medicine
54
What are the Signs and Symptoms?
Stage 1: The Painful Stage
• Achy, dull pain at rest
• Sharp pain at extremes of motion. In other words, when
you move your arm as far as you can in one direction.
• Pain may be worse at night
• As the pain worsens, the shoulder starts to get stiff
• May last from 6 weeks to 9 months
Stage 2: The Stiffening or Frozen Stage
• Pain slowly gets better
• Pain mainly at extremes of motion. In other words, when
you move your arm as far as you can in one direction.
• Stiffness is the biggest problem
• May last from 4 months to 9 months
Stage 3: The Thawing Stage
• Stiffness slowly starts getting better
• May last from 5 months to about 2 years
Key Point: Pain at Rest
Key Point: Stiffness is the biggest problem
Key Point: Pain at Rest
How Can My Doctor Tell If I Have
Frozen Shoulder?
Your doctor can tell you have a frozen shoulder by getting a
good history and doing a good physical exam.
X-rays or an MRI are not needed to make the diagnosis of
frozen shoulder. Sometimes your doctor may get an x-ray or
an MRI to make sure something else isn’t causing your pain or
symptoms.
How is it Treated?
Treatment depends on the stage of the disease. Most patients
will get better with medicine, therapy and sometimes a steroid
injection (or shot).
Stage 1: The Painful Stage
•
You may use your arm in pain-free motions – If it hurts,
don’t do it.
• Your doctor may suggest an anti-inflammatory medicine
(such as Aleve or Naprosyn) to help with the pain and
inflammation.
• Your doctor may suggest giving you a steroid injection
(shot) in your shoulder to help with the pain and
inflammation.
Note: If you have diabetes, a steroid shot may increase your
blood sugar. You should check your sugar closely for 1 - 2 days
after the shot.
• Your doctor may send you to physical therapy or may
suggest some home exercises, depending on the amount
of pain you are having.
Goal: To reduce your pain
Copyright 2010 - Vanderbilt Sports Medicine
36
Who Gets Frozen Shoulder?
• More common in patients 40 to 60 years old
• Slightly more common in women
• Usually affects one shoulder at a time
• Affects non-dominant shoulder slightly more (In other
words, in right-handed patients, the left shoulder is
affected a little bit more often.)
What are some other risk factors for
getting a frozen shoulder?
Many times we never know what causes a frozen shoulder. It
does seem to be more common with certain conditions such as:
• Shoulder injury or surgery: After surgery, an injury, or
overuse (such as painting or working in the garden) you
may have some pain so you favor your shoulder; in other
words, you do not use it normally. The longer you favor
your shoulder, the stiffer it gets.
• A wrist or elbow injury: It may also happen after a wrist
or elbow injury because again you are not using your arm
normally.
• Diabetes: About 1 to 3 out of every 10 people with
diabetes will get a frozen shoulder at some point. High
sugar levels may affect the tissue that makes up the
capsule but we are not sure.
• Other medical problems: Such as heart disease/heart
surgery, thyroid disease and Parkinson’s disease
Stage 2: The Stiffening or Frozen Stage
• When your pain at rest is gone your doctor will send you
to physical therapy to start working on your motion.
• Again your doctor may suggest giving you a steroid
injection (shot) to help decrease the pain.
Stage 3: The Thawing Stage
• Your doctor will continue your therapy. The therapist
or athletic trainer working with you may start to use
different machines or exercises to help increase motion
and to help make the shoulder stronger.
• You will be switched to a home exercise program. The
therapist or athletic trainer will show you what exercises
to do at home and will tell you how many times a day or
week you should do them.
Goal: To start increasing your motion
Goal: To keep increasing your motion
Copyright 2010 - Vanderbilt Sports Medicine
2 7
What is Frozen Shoulder?
Frozen Shoulder, also called Adhesive Capsulitis, causes pain
and stiffness in the shoulder, which can be very severe at times.
With a frozen shoulder the capsule around the shoulder joint
gets thick and scarred (see pictures on page 1), and this limits
the normal motion of the shoulder.
It can be very frustrating for patients because most of the
time the doctors don’t know why it happens and can’t say exactly
how long it will last.
• Pain may start instantly or it may start slowly.
• Stiffness often starts slowly and gets worse with time.
• At times it may be very hard or even impossible to do
simple things like comb your hair or reach in your back
pocket.
• Symptoms may last for up to one year and sometimes
longer.
• Symptoms may go away instantly.
Patients with a frozen shoulder often go through three
stages:
Stage 1: The Painful Stage
Stage 2: The Stiffening or Frozen Stage
Stage 3: The Thawing Stage
Manipulation Under Anesthesia
• While you are under anesthesia your doctor moves your
shoulder in different directions to break up the scar
tissue. Your doctor may do this alone or in addition to
surgery.
Surgery (Arthroscopy, Capsular Release)
• Your doctor uses a camera to look inside your shoulder
and then cuts the scar tissue away. During the surgery,
your doctor will make two small incisions (or cuts) - one
for the camera (arthroscope) and the other one for the
tool(s) needed during surgery. After your doctor cuts the
scar tissue during the arthroscopy, he/she may also do a
manipulation under anesthesia.
Sometimes even though you work hard, you
may not get enough of your motion back.
If this happens and your symptoms have been
going on for many months, your doctor may
suggest surgery and/or a manipulation under
anesthesia.
Copyright 2010 - Vanderbilt Sports Medicine
8 1
The Shoulder Joint
The shoulder joint is made of the humeral head and the
glenoid. The humeral head rests on the glenoid like a golf ball on
a tee.
The joint capsule
is in a sac that covers or
surrounds the shoulder
joint. In normal
shoulders, the joint
capsule has some
looseness which
allows the shoulder to
have full range of
motion.
In a frozen
shoulder, the normal
looseness in the capsule is lost because of the inflammation and
scarring. This causes the shoulder to get stiff.
Frequently Asked Questions
1. Why did I get a Frozen Shoulder?
Many times the cause of frozen shoulder is not known. It
may be related to your diabetes or an injury/surgery of your
shoulder, elbow or wrist. Many times though it starts with no
injury or warning.
2. How long do I have to go to therapy?
The length of therapy varies from patient to patient. It
usually starts in Stage 2 with you going to formal therapy three
times a week. As your pain decreases and your motion starts
to increase your doctor may switch you to a home exercise
program. All in all you may have to do some form of therapy
for several weeks or months.
3. Will I get all of my motion back?
Some patients regain full motion back but other patients
may only get partial motion back. Even if you don’t get your full
motion back, the amount of motion lost does not seem to get
in the way of normal daily activities. In other words, you can
usually do your daily activities without any problems.
4. How can I prevent it from happening to my other
shoulder?
Some patients will get a frozen shoulder in their other
shoulder. It usually occurs within five years, after the first
shoulder has gotten better but again we are not sure why.
If you have an injury to your shoulder or if it starts to
hurt after doing some sort of activity (such as raking leaves or
painting or moving furniture) make an appointment with your
doctor if it doesn’t get better within a couple of days. Do not
wait until you can no longer take the pain or cannot move your
shoulder.
5. Is it normal for my shoulder to hurt so much at
night?
Yes. Many patients with shoulder problems, especially frozen
shoulder, have pain at night and trouble sleeping. Some things
that may help are sleeping more upright, like in a recliner or
propped up on pillows. You may also ask your doctor about
medicine to help you sleep.
Copyright 2010 - Vanderbilt Sports Medicine
For more information on this and other injuries see our website:
www.vanderbiltorthopaedics.com
This information is intended for education of the reader about medical conditions and current
treatments. It is not a substitute for examination, diagnosis, and care provided by your
physician or a licensed healthcare provider. If you believe that you, your child, or someone you
know has the condition described herein, please see your healthcare provider. Do not attempt
to treat yourself or anyone else without proper medical attention. All rights reserved 2010,
Vanderbilt University,Vanderbilt University Medical Center,Vanderbilt Children’s Hospital.
Copyright September 2006, Vanderbilt Orthopaedic Institute: Christie
Henning, ATC/L, MAT, Tara Holmes, PA-C, MPH, Warren R. Dunn, MD,
MPH, Lynn Cain
Copyright 2010 - Vanderbilt Sports Medicine
