Frozen Shoulder – Adhesive Capsulitis
We are an active community here in the Pacific Northwest, from bike commuting, to kayaking and rock climbing to playing with our dogs at the park, shoulder mobility is a part of our everyday lives in ways that we may not even realize. Losing range of motion, or pain with motion of the shoulder can significantly impact one’s day-to-day function and quality of life.
What is adhesive capsulitis, or frozen shoulder?
Adhesive capsulitis, more commonly referred to as frozen shoulder, is a process in which the range of motion in the shoulder joint becomes gradually reduced over time. Additionally, in frozen shoulder there is no evidence on imaging of any underlying process to explain the pain and restricted range of motion.
Frozen shoulder is a condition that is still not completely understood. Arthroscopic examination of patients with the condition has shown evidence of both inflammation and scarring taking place within the shoulder joint, however the underlying mechanism behind the development of these findings is still unclear.
Who gets frozen shoulder?
Frozen shoulder is not an uncommon condition, affecting between 2% and 5% of the population. It is most prevalent in adults between the ages of 50 and 60 and rarely seen in younger individuals. Unfortunately, in affected patients there is about a 15% risk of the other shoulder becoming affected within 5 years.
There are also several diseases associated with the development of frozen shoulder. Patients with diabetes, thyroid disease, autoimmune diseases or a recent stroke have an increased risk of developing frozen shoulder – at this point in time the reasoning behind these associations is not entirely clear.
What are the symptoms of frozen shoulder?
Frozen shoulder is typically described as a progression through 3 different phases.
- A painful phase with severe, diffuse pain in the affected shoulder. The pain is often worse at night and the shoulder becomes increasingly stiff.
- This phase usually lasts 2-9 months
- Improved pain but increasing stiffness.
- This phase typically lasts 4-12 months
- A recovery phase with gradual improvement in range of motion
- This phase typically lasts 5-24 months
When assessed by one of the providers at OSS, they will assess both your active range of motion and passive range of motion (when you relax, and the provider moves your arm for you). Sometimes frozen shoulder is difficult to differentiate from rotator cuff injuries or a condition called subacromial bursitis. Your physician may use a small injection of local anesthetic into the space just above your shoulder joint to help differentiate between these conditions. While the injected anesthetic usually improves symptoms in rotator cuff injuries or subacromial bursitis, it does not have the same effect on patients with true frozen shoulder.
There are not specific imaging findings for frozen shoulder, however your provider may order imaging, such as an x-ray or ultrasound of the shoulder, to rule out other conditions that can present similarly.
How is frozen shoulder treated?
Most commonly frozen shoulder resolves on its own over time. Many patients recover completely, though some report that their shoulder never quite feels the same. Non-steroidal anti-inflammatory (NSAIDs) medications or acetaminophen can be used for pain control as needed and patients are encouraged to continue gentle range of motion exercises to retain as much movement as possible.
For more severe cases or cases not improving with time, some providers may offer two different types of injections into the affected shoulder joint. While both of these approaches can significantly improve pain and increase range of motion initially, their effects are usually short in duration.
Steroid Injection
A steroid injection helps to reduce local inflammation, and therefore pain and stiffness.
Intra-articular Dilation or Distension
A combination of saline and a local anesthetic are injected into the joint space to expand the glenohumeral capsule – this is capsule of ligaments that forms the shoulder joint between your humerus and your scapula. This distension of the joint is thought to provide more space, allowing for increased range of motion and often, as a result, reduced pain.
Surgery has not been shown to be an effective treatment for frozen shoulder. However, your provider may offer what is called “manipulation under anesthesia.” In this procedure the patient is placed under light sedation in an operating room and then their orthopedic surgeon will manipulate the shoulder through its maximum range of motion to loosen as much scar tissue as possible without causing pain to the patient.
