Adhesive Capsulitis

What is adhesive capsulitis?

Adhesive capsulitis is the technical term for "frozen shoulder.:  The shoulder joint is supported by ligaments which connect the shoulder bones together and keep them properly aligned during motion.  Normally the ligaments are flexible enough to permit full movement of the shoulder.  When adhesive capsulitis occurs, the ligaments develop an inflammatory process, causing scar tissue to infiltrate and form very restricting adhesions.  This "freezing" of the joint severely decreases the shoulder's normal range of motion and causes considerable pain during motion.

Who is most at risk?

Women 40 years of age and older are most likely to develop frozen shoulder.  Some medical conditions, such as diabetes, cardiovascular disease, or breast surgery, can be associated with frozen shoulder, but the condition can and often does occur in any healthy individual, man or woman, without any predisposing medical condition or trauma.

How do the symptoms develop?

Adhesive capsulitis progresses through three phases.  The symptoms of the first phase, or "freezing phase" are the onset of generalized pain about the shoulder which increases with movement and results in loss of motion.  Because of the pain resulting from the inflammation, the patient elects to protect the shoulder by not moving it, thereby setting the stage for the scar tissue to infiltrate and bind the shoulder even tighter.

The second phase or "frozen phase:, is distinguished by localized pain and tenderness about the humeral head (ball of the shoulder), and discomfort that seems to worsen at night and often interferes with sleep.  During this phase, the inflammation is slowly subsiding and the scar tissue is maturing.

The final phase, or "thawing phase," embodies a less painful shoulder but with significantly the scar tissue may begin to loosen and shoulder motion can slowly return.

How is adhesive capsulitis diagnosed?

The diagnosis of frozen shoulder is usually made by an orthopaedic surgeon.  The symptoms of shoulder pain are often confused with such things as calcific bursitis, rotator cuff tears, arthritis, or tendinitis.  Although these more serious conditions are thought to sometimes precede adhesive capsulitis, the condition usually is an isolated event.  When the surgeon notices a decrease in shoulder motion, particularly in flexion and rotation, the diagnosis is suspect.  When x rays, an MRI, and a physical exam rule out other causes of pain, then the diagnosis is confirmed.

How is adhesive capsulitis treated?

The treatment of adhesive capsulitis depends on the stage and the severity of the condition.  Often, in the early stages, oral anti-inflammatory medications help to decrease the joint inflammatory reaction, and may thereby decrease the scar tissue formation by allowing more pain-free range of motion.  In addition, physical therapy, including phonophoresis (sometimes with corticosteroids), ultrasound, and hot and cold treatments, can be helpful.  A physical therapist who is familiar with this condition is also very helpful in performing active-assisted and passive gentle manipulative range of motion activities.  Our physical therapists are experts in treating "frozen shoulder"  A home exercise program, using an overhead pulley and stretching activities with a cane or wand, must be included in the therapy program.

Pain or analgesic medicines are often necessary to help with the discomfort, particularly during the "frozen phase."  Non-narcotic medications are preferable such as Vioxx or Celebrex (New non-steroid anti-inflammatories)

Surgery for adhesive capsulitis is limited to manipulation under anesthesia.  In our practice, this is usually performed at outpatient surgery.  With the patient asleep, the physician attempts to manipulate the shoulder through a full range of motion to stretch the tight scar tissue surrounding the joint.  It is sometimes necessary to perform an arthroscopic exam or an open surgical procedure; to release additional adhesion in more severe cases, this may be needed.  After manipulation the patient must continue physical therapy and home exercises.  On rare occasions, two or sometimes three manipulations are needed since the adhesion may reform if the inflammatory process remains active.

To see more information about the shoulder, including video animations of shoulder anatomy and other shoulder injuries and ways to treat them, please click here.

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