Adhesive Capsulitis
Frozen shoulder, or adhesive capsulitis, is a condition characterised by shoulder pain, stiffness and reduced ability to perform daily tasks. In many cases a cause for frozen shoulder cannot be established, although it is sometimes due to minor trauma, surgery or prolonged periods of immobility.
Every joint in the body is surrounded by a joint capsule. The capsule confers stability to the joint, and provides a barrier to keep lubricating (synovial) fluid inside the joint. In frozen shoulder, the capsule surrounding the shoulder joint is too tight, which causes pain with movement, and restricts the range of motion in the affected limb.
Symptoms
Frozen shoulder tends to follow a distinct clinical course that consists of 3 stages.
- Freezing phase: in this first phase, which lasts approximately 6 months, it is painful to move the shoulder in every direction, and range of motion is restricted.
- Frozen phase: in this phase, the pain starts to decrease, but movement in every direction is still restricted.
- Thawing phase: the shoulder is no longer painful, and range of movement begins to increase.
Causes
The bones, ligaments and tendons that make up your shoulder joint are encased in a capsule of connective tissue. Frozen shoulder occurs when this capsule thickens and tightens around the shoulder joint, restricting its movement.
Doctors aren’t sure why this happens to some people and not to others, although it’s more likely to occur in people who have recently experienced prolonged immobilisation of their shoulder, such as after surgery or an arm fracture. Because of the high incidence of frozen shoulder in people with diabetes, there may be an autoimmune basis to the disease.
Risk Factors
Although the exact cause is unknown, certain factors may increase your risk of developing frozen shoulder.
Age and gender
People 40 and older are more likely to experience frozen shoulder. About 70 percent of the people who develop the condition are women.
Immobility
People who have experienced prolonged immobility of their shoulder are at higher risk of developing frozen shoulder. Immobility may be the result of many factors, including:
Rotator cuff injury
Broken arm
Stroke
Recovery from surgery
Systemic diseases
People who have certain medical problems appear to be predisposed to develop frozen shoulder. Examples include:
Diabetes
Overactive thyroid (hyperthyroidism)
Underactive thyroid (hypothyroidism)
Cardiovascular disease
Tuberculosis
Parkinson’s disease
Investigations
Shoulder x-rays are often obtained to check for other diseases known to cause shoulder pain, such as arthritis. Your doctor may order other tests, such as ultrasound or MRI to evaluate the soft tissues in and around the shoulder joint, to check for other sources of shoulder pain.
A Xray of the Left Shoulder showing normal anatomy
Complications
People suffering from frozen shoulder may continue to experience some pain and stiffness for several years.
Treatment
Most frozen shoulder treatment involves controlling shoulder pain and preserving as much range of motion in the shoulder as possible.
Medications
Nonsteroidal anti-inflammatory drugs (NSAIDs). These medications may help relieve pain and inflammation associated with frozen shoulder. paracetamol also may be effective for pain relief.
Corticosteroids. Injecting these anti-inflammatory medications into your shoulder joint may help decrease pain and shorten symptom duration during the initial painful phase. Repeated corticosteroid injections aren’t recommended.
Allied Health
A physiotherapist can teach you exercises to help maintain as much mobility in your shoulder as possible, without stressing your shoulder to the point of causing a lot of pain.
Surgery
Distension. Injecting sterile water into the joint capsule can help stretch the tissue and make it easier to move the joint.
Shoulder manipulation. In this procedure, you’re given general anesthesia and then the doctor moves your shoulder joint in ways that help loosen the tightened tissue.
Surgery. In a small number of cases, especially if your symptoms don’t improve despite other measures, surgery may be an option to remove scar tissue and adhesions from inside your shoulder joint. Doctors usually perform this surgery arthroscopically, with a lighted, tubular instrument inserted through a small incision in your joint.
Looking After Yourself
Continue to use the involved shoulder and extremity in as many daily life activities as possible within the limits of your pain and range of motion constraints. Applying heat or cold to your shoulder can help relieve pain
Alternative Medicine
Acupuncture
Acupuncture is a pain-killing procedure that has been used in China for thousands of years. It involves inserting extremely fine needles in your skin at specific points on your body. Typically, the needles remain in place for 15 to 40 minutes. During that time they may be moved or manipulated. Because the needles are hair thin and flexible and are generally inserted superficially, most acupuncture treatments are relatively painless.
Transcutaneous electrical nerve stimulation (TENS)
A TENS unit delivers a tiny electrical current to key points on a nerve pathway. The current, delivered through electrodes taped to your skin, isn’t painful or harmful. It’s not known exactly how TENS works, but it’s thought that it might stimulate the release of pain-inhibiting molecules (endorphins) or block pain fibres that carry pain impulses.
Seeking Advice
Your Family Doctor (GP)
Your Family Doctor will be able to diagnose and help treat your problem. He or she will be able to
- tell you about your problem
- advise you of the best treatment methods
- prescribe you medications
- and if necessary, refer you to Specialists (Consultants) for further treatment
While you may initially consult your family doctor (GP), he or she may refer you to a doctor who specialises in orthopaedic medicine.
Bring along information about yourself
It can be a great help for your doctor if you bring along the following information about yourself
- A list of your medications, including the name and dosage.
- Information about your medical problems and past treatment
- Previous investigation results, such as xrays and blood tests.
Prepare a list of questions for your doctor
You may want to write a list that includes:
Detailed descriptions of your symptoms
Information about medical problems you’ve had
Information about the medical problems of your parents or siblings
All the medications and dietary supplements you take
Questions you want to ask the doctor
What to expect from your doctor
During the physical exam, your doctor may ask you to perform certain actions, to check for pain and evaluate your range of motion. These may include:
Hands up. Raise both your hands straight up in the air, like a football player who’s just made a touchdown.
Opposite shoulder. Reach across your chest to touch your opposite shoulder.
Back scratch. Starting with the back of your hand against the small of your back, reach upward to touch your opposite shoulder blade.
Your doctor may also ask you to relax your muscles while he or she moves your arm for you. This test can help distinguish between frozen shoulder and a rotator cuff injury.
Your doctor may also check the musculoskeletal and neurological health of your shoulder joint and arm by testing your:
Reflexes
Muscle strength
Muscle tone
Sensation
Prevention
One of the most common causes of frozen shoulder is the immobility that may result during recovery from a shoulder injury, broken arm or a stroke. If you’ve had an injury that makes it difficult to move your shoulder, talk to your doctor about what exercises would be best to stretch the tough capsule around your shoulder joint.