It could be Adhesive Capsulitis (Frozen Shoulder)
By: Camryn Cothran, SPT
Revised: Dr. Darryl Richmond, PT, DPT, MSc
What is adhesive capsulitis?
Adhesive capsulitis, also known as frozen shoulder, is a common painful condition that occurs when the glenohumeral joint begins to thicken and leads to limited range of motion of the shoulder.
70% of women are diagnosed with adhesive capsulitis between the ages of 40 to 59 years old. Hormonal imbalances, menopause, increased ligament and joint laxity, weaker upper body strength, and shorter long bone length do play a factor in women developing frozen shoulder. However, it is unknown why adhesive capsulitis occurs more frequently in women. In addition to, there has been evidence showing that adhesive capsulitis is associated with patients that have diabetes, thyroid disease, autoimmune disease, cerebrovascular disease, coronary artery disease, and Dupuytren’s disease. Patients with these co-morbid conditions are more susceptible to developing adhesive capsulitis, and have been proven to have poorer scores on shoulder assessment forms, social function, and emotional and mental health (Manske & Prohaska, 2008)
Classifications of Adhesive Capsulitis
Adhesive capsulitis can be classified as either primary or secondary.
Primary adhesive capsulitis can progress insidiously, in a subtle way, and idiopathically, spontaneously without a known cause.
Secondary adhesive capsulitis occurs due to trauma or immobilization.
Stages of Adhesive Capsulitis
Freezing stage - Both active and passive range of motion decreases and the shoulder feels stiff and becomes painful to move. This will last between 8 to 9 months. The patient will try to self treat during this stage as the symptoms progress.
Frozen stage - The patient starts to use the arm less and less which will result in limited motion when performing external rotation, shoulder flexion, and internal rotation.
Thawing stage - Gradual improvement of shoulder mobility and range of motion begins to improve
Other symptoms include pain felt near the middle of the arm, unable to sleep on the affected side, and difficulty reaching behind the back or overhead.
Note: Patient education is very important during this process, making sure that the patient knows that it may take years for symptoms to completely subside so they don’t have a huge sense of urgency. (Manske & Prohaska, 2008)
Treatment for Adhesive Capsulitis
The most effective non operative treatment is the combination of Pain relieving injections and physical therapy. Pain, range of motion, and function have been shown to improve when rehabilitation is involved. If physical therapy is prescribed, therapy should include a gentle range of motion exercises so the pain doesn’t worsen.
Taking non steroidal anti inflammatory drugs is proven to assist in short term benefits such as pain relief and the improvement of range of motion.
The use of corticosteroids relieves pain and improves range of motion up to 6 weeks but the use of treatment is not best for long term use and there aren’t any proven benefits. (Ewald, 2011)
Arthroscopic release and repair has been shown to make postoperative range of motion less painful and allows a decrease in recovery time. While under anesthesia, there is manipulation of the joint, which disrupts adhesions, and capsular release. Surgical release of the capsule has been beneficial in those with persistent or severe frozen shoulders. Surgery should be avoided by those who have osteoporosis, or significant osteopenia, who have a history of glenohumeral instability, or those who have already undergone manipulation. This kind of treatment should be considered when other non-operative treatments fail. (Manske & Prohaska, 2008)
If you, or someone you know is dealing with a frozen shoulder or any shoulder issue of any kind please feel free to reach out to us, we are here to help!