Frozen Shoulder & Adhesive Capsulitis

Introduction

Frozen shoulder, also known as adhesive capsulitis, is a frustrating but completely treatable problem. Patients with frozen shoulder will have pain and loss of motion in the shoulder. Most of the time there was not a specific incident or injury that led to the onset of frozen shoulder. We will discussed symptoms of a frozen shoulder and treatment of a frozen shoulder below.

Symptoms of Frozen Shoulder

Frozen shoulder symptoms include:

• Inability to reach above shoulder height
• Inability to throw a ball overhead
• Inability to reach behind your back
• Inability to reach out to your side to get your seatbelt
• Inability to sleep on your side

 

Three Stages of Frozen Shoulder:

1. Freezing – most commonly this stage presents as pain all around the shoulder and a progressive loss of motion. The freezing stage results in the most severe pain and usually last 6-9 weeks.
2. Frozen – the pain will decrease during this stage, but there will continue to be decreased range of motion. The frozen stage usually lasts 4-6 months.
3. Thawing – gradual return to more normal shoulder motion. Commonly there is some weakness during this phase. However the stiffness and pain eventually improve to full, or close to full recovery. To get to full recovery after the thawing stage starts can take 6 months to 2 years if not treated.

Each stage can last up to 6-8 months if untreated. With appropriate treatment, recovery can occur in 3-6 months.

Risk Factors – What is the Main Cause of Frozen Shoulder

Although the main cause of frozen shoulder is not completely understood, there are some medical conditions that it is associated with. In general, people with diabetes, thyroid disorders, other hormone problems, or conditions that result in prolonged immobilization of the shoulder are at a higher risk of getting frozen shoulder. In some cases it is unknown what causes a frozen shoulder.

 

Diagnosis of Frozen Shoulder

The first step toward diagnosis consists of asking specific questions about your medical history and the onset, duration, and types of symptoms you are having. The sports medicine surgeon will then perform a detailed physical examination of your shoulder and neck, and regular x-rays will be taken to rule out any other causes of shoulder pain. An MRI is usually not needed to diagnose frozen shoulder.

 

Treatment for a Frozen Shoulder

The vast majority of the time, treatment of frozen shoulder does not include surgery. We usually start off by ordering specific physical therapy and stretching exercises for the shoulder, in addition to anti-inflammatory medications (NSAIDs). Sometimes we combine this with a corticosteroid injection into the shoulder, especially if it is not improving over the first several weeks.

There are 5 specific areas of the tightened shoulder capsule that must be targeted with the stretches. The areas of the shoulder capsule are referred to as the anteroinferior, anterosuperior, posteroinferior, posterosuperior, and axillary pouch regions. An example of several stretches can be found here. Physical therapy is successful in the vast majority of cases, but it can take up to 3-6 months for complete resolution of symptoms.

If physical therapy is not successful after 3-6 months, surgery may be needed. The surgical procedure is known as arthroscopic surgical release (sometimes call lysis of adhesions, or LOA) and manipulation under anesthesia (MUA). This should be done by a board-certified orthopedic surgeon. When physical therapy is not successful in treating frozen shoulder, surgery will usually result in a complete recovery.

Frequently Asked Questions About Frozen Shoulder & Adhesive Capsulitis