Adhesive capsulitis, commonly referred to as frozen shoulder, is a painful and debilitating condition that affects the shoulder joint. It is characterized by the gradual loss of shoulder mobility and development of stiffness over time. The condition progresses through three stages and can take several months to years to resolve. 5-20% of the population with experience a frozen shoulder at some point, but it is a treatable condition with proper medical guidance and care.
While we still don’t know exactly why a frozen shoulder occurs, it does tend to affect women age 40-70 more than men. There are certain risk factors that increase the risk of developing a frozen shoulder, such as diabetes, thyroid issues, hormone changes such as menopause, and immobilization due to a previous shoulder injury.
To understand what a frozen shoulder is, it is helpful to know the anatomy of the shoulder. Your shoulder is a ball-and-socket joint made up of your humerus, scapula, and clavicle. The head of the humerus fits into a shallow socket in your scapula, and the capsule, which is made up of strong connective tissue, surrounds the joint. The capsule provides stability to the shoulder joint as well as lubricates the joint with synovial fluid.
In a frozen shoulder, the shoulder capsule will thicken and adhesions, which are thick bands of tissue, develop. There is also less synovial fluid in the joint, and this causes the shoulder joint to become stiff and painful. Often the shoulder range of motion is limited in what is called a capsular pattern, meaning you lose more motion in external rotation, followed by flexion/abduction, and then internal rotation.
There are three main stages of a frozen shoulder, and the amount of time spent in each stage varies from individual to individual.
- Freezing Stage: This stage is characterized by the gradual onset of shoulder pain, often worsening at night. The pain may be felt deep in the shoulder and can limit shoulder movement.
- Freezing Stage: This stage is characterized by stiffness and limited range of motion along with shoulder pain. Activities that involve raising the arm, reaching behind the back, or rotating the shoulder become difficult.
- Thawing Stage: During this stage, the shoulder begins to improve in terms of mobility and pain. Full recovery can take several months to years.
It is important to have a health care professional diagnose a frozen shoulder and to rule out any other similar diagnoses such as a rotator cuff tear or impingement. Diagnosis typically involves:
- Medical history: Discussing your symptoms, medical history, and any previous injuries or conditions.
- Physical examination: Assessing the range of motion in your shoulder and perform specific tests to check for stiffness and pain.
- Imaging: X-ray, MRI, or ultrasound may be used to rule out other conditions and assess the extent of joint inflammation.
Treatment of a frozen shoulder focuses on reducing pain, improving shoulder mobility, and managing the underlying causes. Treatment options include:
- Physical Therapy: A physical therapist will focus on improving shoulder joint mobility and range of motion through various interventions, such as joint mobilization, stretching, functional dry needling, and soft tissue mobilization. It is important to ensure the scapula and thoracic spine are not restricted as these play an important role in any shoulder range of motion above shoulder level.
- Pain management: NSAIDS or prescription pain medication may be prescribed, as well as a corticosteroid injection, to help manage pain and inflammation.
- Home Exercises: A physical therapist will prescribe specific exercises to perform at home to help improve and maintain shoulder mobility.
- Joint Distension and Hydrodilation: These procedures involve injecting fluids into the joint capsule to stretch it and improve mobility.
- Manipulation Under Anesthesia (MUA): In rare cases, an MUA may be performed to break up the adhesions while the patient is under anesthesia. This is followed by physical therapy to help maintain the shoulder range of motion gained from the MUA.
- Surgery: Surgical intervention is considered a last resort and may involve an arthroscopic release or open release to remove scar tissue and release the joint capsule.
It’s important to note that a frozen shoulder can take a long time resolve, often several months to a couple of years. Patience and consistent adherence to treatment recommendations are key. Your healthcare provider will develop a treatment plan tailored to your specific condition and symptoms. Always consult with a healthcare professional for a proper evaluation and personalized treatment plan for frozen shoulder.