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As many as 2.5 million Americans, three-fourths of them women, suffer from "frozen shoulder" -- a disorder that has nothing at all to do with the cold, but involves the inability to move the shoulder without pain.

When shoulder pain and discomfort impact on quality of life, people generally make their way to an orthopedic office for help. And almost always, the orthopedist has good news: The shoulder will get better by itself.

The physician, however, isn't going to be able to tell you why the condition occurred or the reason it has singled you out. No one knows the answers, although suspected culprits include genetics, viral infections or autoimmune disorders.

Because no one knows the cause -- and the cause may be different for different individuals -- there is no definitive way to prevent frozen shoulder.

Medically known as adhesive capsulitis, frozen shoulder occurs insidiously. A person perceives a slight stiffness and tries to stretch the shoulder muscles, only to experience even more pain and further limited movement -- a pattern that, for some, continues until the shoulder and arm are almost useless. Most people find that frozen shoulder creeps up on them gradually and are unable to pinpoint when the problem surfaced.

Another mystery is that it affects three women for every man, most often between the ages of 40 and 60. What we do know is that frozen shoulder signals some type of inflammation between bones and muscles. The inflamed tissues adhere to other tissues, limiting motion and causing pain when movement separates the adhesions.

Although definitive studies are not yet available, physicians recommend that patients with frozen shoulder begin range-of-motion exercises immediately to speed recovery, which can take 12 to 18 months.

Often frozen shoulder goes away on its own -- although, for some, this is only a temporary reprieve. In virtually every case, again unknown why, the condition will not recur in the same shoulder. In one of five patients, frozen shoulder will occur in the opposite arm. Rarely does frozen shoulder affect both sides of the body at the same time.

People who experience any shoulder discomfort should consult an orthopedic specialist to rule out possible neurological causes. The quicker the frozen shoulder is seen by a physician, the sooner rehabilitation with proper exercises can be initiated. Anti-inflammatory medications and/or pain relievers can offer symptom relief along with simple stretching exercises. An orthopedist is likely to give you a sheet of instructions so you can do these exercises at home and will usually schedule a return visit after six months.

In about 5 percent of patients, the exercises do not help and the condition lingers. For these patients, surgery may be necessary. A surgeon will locate the adhesions and physically cut them apart, giving patients freedom to move their shoulders normally again. The surgery, done under localized anesthesia, takes about 45 minutes.

Studies are under way to determine if physicians can predict which patients suffering frozen shoulder will require surgery. Right now, severity of pain alone does not seem to determine whether the disorder will resolve on its own.

People who suffer shoulder pain and are told by a doctor they have a rotator cuff tear would be wise to seek a second opinion. Frozen shoulder -- when viewed on certain imaging tests -- can mimic rotator cuff injury, leading patients to unnecessary surgery.

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