Adhesive Capsulitis

What is adhesive capsulitis/frozen shoulder?

Adhesive capsulitis is an inflammatory condition in which the shoulder capsule thickens and contracts. This results in severe pain and stiffness. Frozen shoulder exists in three stages.

Stage 1: Freezing

• In the “freezing” stage, patients experience worsening pain and the gradual onset of stiffness. Patients have difficulty sleeping during this stage.

Stage 2: Frozen

• In the “frozen” stage, pain often improves, but the stiffness persists. The stiffness is often profound enough to limit activities of daily living, such as dressing oneself or reaching overhead.

Stage 3: Thawing

• Motion improves slowly during the “thawing” stage. In the absence of treatment, restoration of normal motion can take from 6 months to 2 years.

What causes adhesive capsulitis/frozen shoulder?

In most cases, there is no clear cause of adhesive capsulitis. In some cases, it can be precipitated by trauma or surgery. Frozen shoulder is associated with diabetes and thyroid disorders. It is also more common in women aged 40-60. Frozen shoulder, though, can affect people of all ages and genders.

What are the symptoms of adhesive capsulitis/frozen shoulder?

Patients with frozen shoulder will often describe a constant pain at rest that worsens significantly with even simple motions or actions, such as reaching for an object. Patients report pain in the front and side of the shoulder that frequently radiates to the elbow.

How is adhesive capsulitis/frozen shoulder diagnosed?

Adhesive capsulitis is diagnosed using a combination of patient history, physical examination, and X-rays. X-rays are helpful in ruling out other diseases that cause pain and stiffness, such as arthritis.

A loss of passive motion is a hallmark of frozen shoulder. Passive motion is the range of motion achieved when someone else attempts to move your shoulder. Active motion refers to the range of motion achieved when you move your shoulder on your own. Equal lossees in passive and active range of motion is common in frozen shoulder.

How is adhesive capsulitis/frozen shoulder treated?

Because frozen shoulder is an inflammatory process, it is treated with anti-inflammatories.

Dr. Dare will typically recommend a steroid injection combined with non-steroidal anti-inflammatories (NSAIDs). This will alleviate pain and must then be combined with a daily stretching program. Patients often improve more expeditiously under the care of a physical therapist.

For those that remain stiff despite these interventions, Dr. Dare will often recommend a hydrodilation procedure. This is a minimally invasive intervention performed by a radiologist. The shoulder is injected with a large volume of sterile fluid to expand and stretch the shoulder capsule.

Non-operative treatment is successful in a large majority of patients. For those patients that do not obtain satisfactory pain relief or motion, a surgical intervention, which includes a release of the affected structures, is offered.