Q & A: About Adhesive Capsulitis or "Frozen Shoulder"
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 when in motion. Normally, the ligaments are flexible enough to permit full movement of the shoulder. When adhesive capsulitis occurs, the ligaments develop and inflammatory process, causing them to be infiltrated with scar tissue and form very restricting adhesions. This “freezing” of the joint severely decreases the shoulder’s normal range of motion, and can cause a considerable amount of pain when motion is attempted.
Who is most at risk for this problem? 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 normal individual - male or female - without a predisposing medical condition or trauma.
How do the symptoms develop? "Frozen shoulder" generally progresses through three phases. Symptoms of the first phase are the insidious onset of generalized pain above the shoulder, which increases with movement and results in loss of motion. It is felt that 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 that binds the shoulder even tighter.
The second or "frozen" phase is distinguished by localized pain and tenderness around the humeral head (ball of the shoulder), and discomfort that seems to worsen and night and often interferes with sleep. During this phase, the inflammation is slowly subsiding and the scar tissue is maturing.
The final or "thawing" phase embodies a less painful shoulder but with significantly decreased range of motion. During this phase, the scar tissue may begin loosening up and shoulder motion can slowly return.
How is the diagnosis made? The diagnosis of "frozen shoulder" is usually made by orthopaedic surgeon. The symptoms of shoulder pain are often confused with such things as calcific bursitis, rotator cuff ears, arthritis and tendonitis. Although these more serious conditions are thought to sometimes precede "frozen shoulder," this is not necessarily true and the condition is an isolated event. When the surgeon notices decreased shoulder motion - particularly in flexion and rotation - the diagnosis is suspect. When c-rays, MRI and physical exam rule out other causes of pain, the diagnosis is confirmed.
How is the condition treated? Treatment depends on the stage and severity of the condition. Often, in the early stages, oral anti-inflammatory medications are helpful to decrease the joint inflammatory reaction, thereby decreasing the scar tissue formation by allowing more pain-free range of motion. In addition, physical therapy modalities – 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. Frequently this is best done in a warm therapy swimming pool. A home exercise program using overhead pulley and stretching activities with a cane or wan must be included in the therapy program. A Shoulder Therapy Kit (STK) provides all the necessary equipment for these home exercises. Pain or analgesic medicines are often necessary to help with the discomfort, particularly during the "frozen phase." Non-narcotic medications are preferable. Darvocet or Extra-Strength Tylenol ad usually subscribed.
Surgery for "frozen shoulder" is limited to manipulation under anesthesia. In our practice, this is usually performed in the hospital outpatient department. 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. With severe cases, it is sometimes necessary to perform an arthroscopic exam or an open surgical procedure to release addition adhesions. Following manipulation, the patient must continue physical therapy And home exercises. On occasion, two or sometimes three manipulations are needed, since the adhesions may re-form if the inflammatory process remains active.
What is the long-term outlook for "frozen shoulder?" Most cases are eventually resolved -- either spontaneously, with physical therapy or with manipulation. This condition does not lead to arthritis or rotator cuff tendon damage. Despite the fact that the shoulder is considerably disabled for a prolonged period of time, within two years most “frozen shoulder” cases have resolved. This is the most important thing for a patient to realize, as well as the fact that the condition seldom returns.
If I have any further questions, who can I call? Please feel free to call Anne Arundel Orthopaedic Surgeons, P.A., at 410-573-2530 or 1-800-331-2466 and ask for an appointment with a shoulder specialist. One of our physicians will be happy to answer your questions and evaluate your shoulder in the office.
Q & A: About Adhesive Capsulitis or "Frozen Shoulder"