Frozen Shoulder (Adhesive Capsulitis)
Frozen shoulder (adhesive capsulitis) is stiffness, pain, and limited range of movement in your shoulder that may follow an injury. The tissues around the joint stiffen, scar tissue forms, and shoulder movements become difficult and painful. The condition usually comes on slowly, then goes away slowly over the course of several months or longer
Why it Occurs
Frozen shoulder can develop when you stop using the joint normally because of pain, injury, or a chronic health condition, such as diabetes or arthritis. Any shoulder problem can lead to frozen shoulder if you do not work to keep full range of motion.
Frozen shoulder can occur:
- • After surgery or injury.
• Most often in people 40 to 70 years old.
• More often in women (especially in postmenopausal women) than in men.
• Most often in people with chronic diseases.
One sign of a frozen shoulder is that the joint becomes so tight and stiff that it is nearly impossible to carry out simple movements, such as raising the arm. The movement that is most severely inhibited is external rotation of the shoulder.
People complain that the stiffness and pain worsen at night. Pain due to frozen shoulder is usually dull or aching. It can be worsened with attempted motion, or if bumped. A physical therapist or chiropractor may suspect the patient has a frozen shoulder if a physical examination reveals limited shoulder movement. Frozen shoulder can be diagnosed if limits to the active range of motion (range of motion from active use of muscles) are the same or almost the same as the limits to the passive range of motion (range of motion from a person manipulating the arm and shoulder). An arthrogram or an MRI scan may confirm the diagnosis, though in practice this is rarely required.
The normal course of a frozen shoulder has been described as having three stages.
- • Stage one: The “freezing” or painful stage, which may last from six weeks to nine months, and in which the patient has a slow onset of pain. As the pain worsens, the shoulder loses motion.
• Stage two: The “frozen” or adhesive stage is marked by a slow improvement in pain but the stiffness remains. This stage generally lasts from four to nine months.
• Stage three: The “thawing” or recovery, when shoulder motion slowly returns toward normal. This generally lasts from 5 to 26 months.
Treatment for frozen shoulder usually starts with nonsteroidal anti-inflammatory drugs (NSAIDs) and application of heat to the affected area, followed by gentle stretching. Ice and medicines (including corticosteroid injections into muscle trigger points) may also be used to reduce pain and swelling. And physical therapy can help increase your range of motion. A frozen shoulder can take many months to get better. But if treatment is not helping, injection with ultra sound guidance into the joint may be helpful in restoring movement while decreasing pain and discomfort. If conservative management and injection therapy is not restoring function arthroscopic surgery is rarely sometimes done to cut some of the tight tissues around the shoulder.
Treatment may be painful and taxing and consists of physical therapy, occupational therapy, Chiropractic, medication, massage therapy, hydrodilatation or surgery. A doctor may also perform manipulation under anesthesia, which breaks up the adhesions and scar tissue in the joint to help restore some range of motion. Pain and inflammation can be controlled with analgesics and NSAIDs. The condition tends to be self-limiting: it usually resolves over time without surgery, but this may take up to two years. Most people regain about 90% of shoulder motion over time. People who suffer from adhesive capsulitis may have extreme difficulty working and going about normal life activities for several months or longer.