The shoulder joint is surrounded by tissue called a capsule. This contains the lubricating fluid that helps the shoulder to glide smoothly inside of the joint. Normally, the capsule has folds that can expand and contract as the arm moves in order to keep the shoulder flexible.
Adhesive Capsulitis (Frozen Shoulder)
Adhesive capsulitis is a condition that causes the shoulder to be painful and stiff (frozen).
The normally flexible capsule becomes inflamed and scarring (adhesions) develops. As the tissue becomes more scarred and tightened, the shoulder motion becomes restricted. It becomes very painful to move the shoulder.
The cause of frozen shoulder is not completely understood, but is most often caused by inflammation (swelling and irritation) to the tissues surrounding the joint. This can be because of trauma, wear and tear, bursitis or tendinitis (inflammation of the shoulder bursa or tendons). Another cause can be due to immobilization of the arm (after an injury, for example).
Patients with medical conditions such as diabetes, thyroid disorders, and smoking are at higher risk of developing frozen shoulder. In addition, females in their 40s-50s tend to develop this condition more often than others.
Primary symptoms include pain and stiffness. The stiffness usually prevents patients from being able to move the arm through a full range, even with help.
There are different phases of a frozen shoulder, as well. It can sometimes take up to 6-9 months to move through these phases completely.
- Pre-freezing phase is characterized by pain with no major loss of motion
- Freezing phase is characterized by ongoing pain with worsening loss of motion
- Frozen phase is characterized by the most pain and the most severe loss of motion
- Thawing phase is characterized by gradual return of motion and decreasing pain
You will be evaluated by your provider who will perform an examination of the shoulder.
Tests such as an x-ray or MRI may be ordered to rule out other conditions like arthritis, calcium deposits, or rotator cuff tears that can also cause pain and loss of motion.
Initial management is focused on decreasing inflammation. This includes medications that can be taken by mouth such as non-steroidal anti-inflammatory medications or steroid medications. Steroid injections can also be administered directly into the shoulder joint.
In addition to medication, physical therapy and home exercises are also a very important component to getting better. The exercises are focused on moving and stretching the arm frequently to help loosen the capsule again. In addition, using modalities such as ice, heat, ultrasound or electrical stimulation can also be helpful. Doing the exercises at least 2-3 times per day is very important. Therapy typically lasts anywhere from 4-8 weeks, though it can be longer or shorter depending on progress and how often exercises are being performed at home.
In total, with conservative measures, the entire process can sometimes take up to six to nine months for some patients, though it may be shorter for others.
Surgery can be indicated if the range of motion does not improve over the course of several months of attempts at conservative management.
Arthroscopic surgery: Surgical intervention is focused on breaking up the scar tissue and stiff joint capsule. This minimally invasive surgery uses an arthroscope (camera) and other instruments to help to primarily remove inflammation and scar tissue in the shoulder. In addition, other problems that can cause inflammation in the shoulder are usually addressed at the same time. These include relocation of the biceps tendon, shaving down bone spurs and repairing any existing damage to the rotator cuff that may be causing pain.