Adhesive capsulitis, more commonly referred to as frozen shoulder, is a condition that causes pain and stiffness in the shoulder. Eventually, it becomes very hard to move the shoulder.
This condition affects about 2 percent of the general population, and is most commonly experienced in people between the ages of 40 and 60. Women are more likely to experience frozen shoulder than men. Postmenopausal women are especially prone to developing a frozen shoulder.
Frozen Shoulder Symptoms
With adhesive capsulitis, the normally thin flexible capsule surrounding the shoulder becomes tight and thick, when adhesion (or stiff bands of tissue) develop. Frozen shoulder usually develops slowly, and in three stages:
- Freezing stage – During this stage, any movement of the shoulder can cause pain. Additionally, the range of motion becomes limited.
- Frozen stage – The pain in the shoulder diminishes during this stage; however, the shoulder becomes more difficult to use as it becomes stiffer.
- Thawing stage – The range of motion in the shoulder starts to return during this stage.
Each of the three stages can last for many months.
Causes and Risk Factors
Frozen shoulder occurs when you stop using the joint as you normally would as a result of pain, injury to the shoulder, or the development of a chronic health condition, such as diabetes or stroke. Any condition of the shoulder can lead to frozen shoulder if you stop using the full range of motion of the joint.
Frozen shoulder generally occurs:
- In people between the ages of 40 and 70 years old
- After shoulder surgery or an injury to the joint
- After keeping the shoulder immobilized for an extended period of time
- Occurs more commonly in women, especially those postmenopausal
- In people who suffer from chronic diseases, such as diabetes
The initial diagnosis of a frozen shoulder begins with your doctor taking a full medical history and by performing a physical examination. During the physical exam, your doctor will ask you to do a number of things, including:
- Move your arm independently in certain ways to check for pain and evaluate the range of motion. This is known as active range of motion.
- Asking you to relax your arm, while he or she moves it for you. This is known as passive range of motion.
- Inject an anesthetic, or a numbing medicine, into your shoulder, to treat the pain and to determine the passive and active range of motion (both the passive and active range of motion are affected by a frozen shoulder.)
While frozen shoulder can usually be diagnosed from the signs and symptoms alone, an imaging test, such as an X-ray or an MRI, may be ordered to rule out other problems with the shoulder.
Treatments Options and Procedures
Non-surgical and surgical treatments are both used to treat frozen shoulder.
Non-surgical treatment methods include:
- Non-steroidal anti-inflammatory drugs, which reduce swelling and help to manage pain
- Steroid injections, which also reduce swelling and minimize pain
- Treatment of underlying risk factors that lead to the frozen shoulder
- Physical therapy can increase the range of motion and hasten recovery
Surgical intervention may be recommended when non-surgical treatment methods are not showing progress. During surgery the tight tissue around the shoulder are released, improving the range of motion.
Arthroscopy, performed by an orthopaedic surgeon, is the preferred treatment method, as it is less invasive than other surgical methods. Shoulder arthroscopy typically involves the surgeon making two or three tiny incisions around the area of the shoulder joint. During arthroscopic frozen shoulder surgery, tight tissue and scar tissue is released and the shoulder is manipulated while the patient is asleep in order to regain normal motion.
Recovery from frozen shoulder involves immediate and frequent physical therapy, focusing on strengthening the muscles and improving range of motion. Recovery time varies from person to person, but following the recommendations made by your doctors is imperative, as this will help to ensure proper healing.
Frequently Asked Questions
Can frozen shoulder cause pain in other areas of the body?
Patients typically experience pain over the sides and front of their shoulder and in their upper arm region (around the biceps, rotator cuff, and deltoid muscles). This pain can radiate down the elbow to the wrist, as well as around the upper part of your back from the trapezius muscle due to joint space restriction. Pain can occur with movement, or even at rest.
Will frozen shoulder go away without medical intervention?
It's unlikely your frozen shoulder (adhesive capsulitis) will go away on its own. Frozen shoulder is caused by a buildup of scar tissue, which will not resolve without medical intervention.
Many patients who don't seek treatment do function without pain, but typically lose some end-range motion.
Can frozen shoulder recur?
While it is uncommon, a frozen shoulder may recur, particularly if you have diabetes or other contributing factors. However, usually people who do experience a recurrence have it develop in the opposite shoulder and not in the initial shoulder.
Why is frozen shoulder common in diabetic patients?
It is unknown why diabetic patients commonly get frozen shoulder. Diabetics, regardless of treatment, tend to experience a worse outcome and are at risk when they have increased diabetes duration, increased age, and diabetic neuropathy.