Frozen Shoulder

Adhesive Capsulitis – also known as Frozen Shoulder – is a common cause of pain which affects up to five percent of adults.  This article will cover everything you need to know about recognizing Adhesive Capsulitis and how to treat it.

Understanding the shoulder

The shoulder joint is made up of three bones: the humerus (long bone in the upper arm), the clavicle (collar bone), and the scapula (shoulder blade), with connective tissues that make up your shoulder capsule.  Inside this capsule is synovial fluid (fluid which lubricates the bones and connective tissue).

Who gets Adhesive Capsulitis?

Most commonly, Adhesive Capsulitis occurs in adults 40-60 year olds (more often in women).  Individuals with diabetes or thyroid conditions are at an increased risk of developing Adhesive Capsulitis.   Other medical conditions increase your risk of Adhesive Capsulitis as well, such as strokes and Parkinson’s disease.  You can also get secondary Adhesive Capsulitis, which occurs after shoulder injuries (rotator cuff tears and proximal humerus fractures) or shoulder surgery.

What causes Adhesive Capsulitis?  

While the cause is not fully understood, a common thought involves inflammation in the shoulder joint capsule which then leads to the development of adhesion and fibrosis in the synovial lining.  This causes the shoulder joint to thicken and contract, leading to restricted range of motion.

What are the symptoms of Adhesive Capsulitis?

Most individuals experience a stiff and painful shoulder.  They will have trouble reaching overhead and behind the back.  In addition, some patients will experience weakness in the joint.

What are the stages of Adhesive Capsulitis?

1st stage – Freezing: Diffuse, severe and disabling pain in the shoulder with increasing stiffness. This phase can last 2-9 months.

2nd stage – Frozen: Stiffness and severe loss of shoulder motion; pain is gradually decreasing.  This phase lasts 4-12 months.

3rd stage – Thawing: Recovery with gradual return of motion. This can take 5-24 months. Adhesive Capsulitis affects only one shoulder at a time and can resolve on its own in 2-3 years or longer.  Due to the significant impact of joint function and discomfort caused by Adhesive Capsulitis, most people seek treatment to reduce the length of recovery time.

Diagnosis of Adhesive Capsulitis

An orthopaedic surgeon can diagnose Adhesive Capsulitis with a physical exam.  Most patients present with pain and significantly reduced active and passive range of motion.  X-rays are beneficial to rule out other shoulder conditions such as shoulder osteoarthritis, which can mimic symptoms of Adhesive Capsulitis.  We can use musculoskeletal ultrasound to see thickening of the joint capsule, increased fluid in the joint and rule out any rotator cuff tear.

What is the treatment of Adhesive Capsulitis?

First step:  

  • Non-steroidal Anti-Inflammatory Drugs (NSAIDS)
  • Prednisone
  • Cortisone injection
  • Physical therapy

NSAIDs, prednisone dose pack or shoulder joint injection with corticosteroid and physical therapy.  The NSAIDs or steroid and prednisone dose pack will decrease the inflammation in the joint, and physical therapy will help break up the adhesions that have formed to get full range of motion back.  This treatment requires 3-4 weeks to work.

Second step:

If there is no (or minimal) improvement with the first step, the next course of action is a closed manipulation.  This is an outpatient procedure. The orthopaedic surgeon moves your shoulder through full range of motion to break up the adhesions and then injects the shoulder with a steroid.  After the procedure, physical therapy is prescribed to prevent the adhesions from reoccurring.