Adhesive Capsulitis

What is Adhesive Capsulitis, or frozen shoulder?

The terms frozen shoulder and adhesive capsulitis are often used interchangeably. In other words, the two terms describe the same painful, stiff condition of the shoulder regardless of what causes it.

Adhesive capsulitis can be categorized into two types:

1) Primary Adhesive Capsulitis

  • Affects the fibrous ligaments that surround the shoulder forming the joint capsule

2) Secondary Adhesive Capsulitis (true frozen shoulder)

  • May have some joint capsule changes but the shoulder stiffness is really coming from something outside the joint.
    • Associated condition: Rotator cuff tears, Biceps tendonitis, Arthritis

Typically, a frozen shoulder develops in three stages:

1) Painful stage "Freezing"

  • Pain with movement
    • Generalized ache that is difficult to pinpoint
    • Muscle spasm
    • Increasing pain at night and at rest

2) Adhesive stage "Frozen"

  • Less pain
  • Increasing stiffness and restriction of movement
  • Decreasing pain at night and at rest
  • Discomfort felt at extreme ranges of movement

3) Recovery stage "Thawing"

  • Decreased pain
  • Marked restriction with slow, gradual increase in range of motion
  • Recovery is spontaneous but frequently incomplete

Anatomy

Your shoulder is made up of three bones:

  • your upper arm bone (humerus)
  • your shoulder blade (scapula)
  • your collarbone (clavicle)

The shoulder is a ball-and-sock et joint: The ball , or he ad, of your upper arm bone fits into a shallow socket (glenoid fossa) in your shoulder blade.

Your arm is kept in your shoulder socket by your rotator cuff. The rotator cuff is a network of four muscles that come together as tendons to form a covering around the head of the humerus.

The joint capsule is a watertight sac that encloses the joint and the fluids that bathe and lubricate it. The walls of the joint capsule are made up of ligaments. Ligaments are soft connective tissues that attach bones to bones. The joint capsule has a considerable amount of slack, loose tissue, so the shoulder is unrestricted as it moves through its large range of motion.

Cause

The causes of frozen shoulder are not fully understood. There is no clear connection to arm dominance or occupation. A few factors may put you more at risk for developing frozen shoulder.

  • Diabetes. Frozen shoulder occurs much more often in people with diabetes, affecting 10% to 20% of these individuals. The reason for this is not known.
  • Other diseases. Some additional medical problems associated with frozen shoulder include hypothyroidism, hyperthyroidism, Parkinson's disease, and cardiac disease.
  • Immobilization. Frozen shoulder can develop after a shoulder has been immobilized for a period of time due to surgery, a fracture, or other injury. Having patients move their shoulders soon after injury or surgery is one measure prescribed to prevent frozen shoulder.
  • Other shoulder problems. Rotator cuff tears, bursitis, or impingement syndrome can end up causing a frozen shoulder. 

Symptoms

The symptoms of adhesive capsulitis (and frozen shoulder) are primarily shoulder pain and stiffness, resulting in a very reduced range of shoulder motion. The tightness in the shoulder can make it difficult to do regular activities like getting dressed, combing your hair, or reaching across a table.

Pain from frozen shoulder is usually dull or aching. It is typically worse early in the course of the disease and when you move your arm. The pain is usually located over the outer shoulder area and sometimes the upper arm.

Diagnosis

Your Physical Therapist will ask questions about your medical history, your injury, and your pain. Your PT will then do a physical examination of the shoulder. The physical exam is most helpful in diagnosing a frozen shoulder. Typically, you will have a loss of motion in your shoulder with pain.

Your doctor  may order x-rays of the shoulder to make sure there is no other problem, such as arthritis or impingement. Sometimes an MRI exam may show inflammation, but there are no specific signs to diagnose frozen shoulder.

Treatment

Treatment of frozen shoulder can be frustrating and slow. Most cases eventually improve, but the process may take months. Physical Therapy treatments are a critical part of helping you regain the motion and function of your shoulder. Initially, the goal will to be to decrease inflammation and increase the range of motion of your shoulder.

Hands-on therapy and heat may be used to stretch the joint capsule and muscle tissues of the shoulder. We will also provide specific exercises and stretches to do as part of your home program. Although the time required for recovery varies, as a guideline, you may need therapy treatment s for about three to six months before you get full shoulder motion and function back.

If your pain is too strong at first to begin working on shoulder movement, our therapist may need to start with treatments to help control pain. Treatments to ease pain include ice, heat, ultrasound, and electrical stimulation. Massage or other types of hands-on treatments to ease muscle spasm and pain may also be focused on.

If physical therapy for does not work for you, your doctor may recommend surgical treatment. However, physical therapy for the frozen shoulder is usually enough for 90% patients to get effective results that improve with time.