Shoulder fibrosis is a condition marked by the excessive growth of fibrous connective tissue, similar to scar tissue, within the shoulder’s joint capsule. This capsule, a sac of ligaments and connective tissue surrounding the joint, allows for a wide range of movement. When it becomes inflamed and thickened, the result is significant pain and a progressive stiffening of the joint. This process shrinks the available space for the joint to move, leading to the condition’s characteristic functional limitations.
Primary Causes of Shoulder Stiffness
Shoulder fibrosis can often occur without a clear trigger, a condition known as primary adhesive capsulitis or, more commonly, “frozen shoulder.” In these instances, the process begins spontaneously with inflammation inside the joint capsule. This inflammation leads to the formation of fibrotic bands, or adhesions, that cause the capsule to thicken and tighten. While the exact reason for this spontaneous onset is not fully understood, it represents a significant portion of cases.
Secondary shoulder fibrosis arises as a direct consequence of a specific event. This can include trauma, such as a fracture of the arm, or following surgical procedures like rotator cuff repair. Prolonged periods of immobilization, from being in a sling after an injury or due to a stroke, can also initiate fibrotic changes. The lack of movement contributes to the development of scar tissue that restricts joint motion.
Certain systemic health conditions also increase an individual’s susceptibility to developing shoulder fibrosis. People with diabetes are at a notably higher risk. Other conditions that can predispose someone to shoulder fibrosis include thyroid disorders, both overactive and underactive, and cardiovascular diseases. The precise link between these systemic diseases and the fibrotic process in the shoulder is an area of ongoing investigation.
Recognizable Symptoms and Progression
Shoulder fibrosis is defined by two primary symptoms: a persistent, dull, or aching pain and a substantial loss of mobility. The pain is often located over the outer shoulder area and can radiate down the arm. Many individuals report that the pain intensifies at night, frequently disrupting sleep and making it difficult to lie on the affected side. This discomfort is coupled with a progressive stiffness that makes everyday activities challenging.
This loss of motion significantly impacts daily life. Functional limitations often include an inability to reach overhead, making it hard to place items on a high shelf or comb one’s hair. Reaching behind the back to fasten a bra or tuck in a shirt can become impossible. These difficulties are a direct result of the tightening joint capsule blocking the arm’s normal movement.
The condition typically unfolds in three distinct, overlapping stages. The initial “freezing” phase is characterized by the gradual onset of pain and increasing stiffness over two to nine months. Following this is the “frozen” stage, where pain may subside, but stiffness peaks and severely limits movement. The final “thawing” stage marks a slow improvement in range of motion as the shoulder loosens, a process that can last for many months.
The Diagnostic Pathway
Diagnosing shoulder fibrosis begins with a thorough physical examination. A primary indicator is the loss of both active and passive range of motion. Active motion is the patient’s ability to move their own arm, while passive motion involves the examiner moving the patient’s arm. In shoulder fibrosis, both types of movement are significantly restricted, particularly external rotation.
Imaging studies are often used to support the diagnosis and to exclude other potential causes of shoulder pain and stiffness. An X-ray is commonly performed first to rule out structural issues like osteoarthritis or fractures. While an X-ray does not show the joint capsule’s soft tissues, it is a valuable step in narrowing down the diagnosis.
For a more detailed view of the soft tissues, a magnetic resonance imaging (MRI) or an ultrasound may be ordered. These techniques can directly visualize the thickened joint capsule, confirming fibrosis and inflammation. In many cases where the physical exam findings are clear, these advanced imaging studies may not be necessary for a diagnosis.
Treatment and Rehabilitation Methods
The foundation of treatment for shoulder fibrosis is non-surgical, emphasizing physical therapy and targeted stretching. The goal of rehabilitation is to stretch the stiffened joint capsule and restore the lost range of motion. A therapist guides the patient through specific exercises to gently push the limits of movement. Consistency with this daily exercise program is a large factor in a successful recovery.
Medical treatments are often used with physical therapy to manage pain and reduce inflammation. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) can alleviate discomfort, making it easier to perform stretching exercises. For more significant pain, a corticosteroid injection into the shoulder joint can provide powerful anti-inflammatory effects, allowing for more effective participation in therapy.
In a small number of persistent cases where conservative treatments do not yield sufficient improvement, more invasive procedures may be considered. One option is manipulation under anesthesia, where a surgeon moves the shoulder through a full range of motion while the patient is asleep, breaking up the scar tissue. Another surgical option is an arthroscopic capsular release, a minimally invasive procedure where the surgeon cuts through the tightened portions of the joint capsule. The vast majority of individuals, however, achieve resolution through non-surgical methods.