All You Need to Know About Frozen Shoulder

Adhesive Capsulitis, also known as Frozen Shoulder, is a common cause of pain in the shoulder.   It effects up to 5% of adults. Here is all you will need to know about recognizing adhesive capsulitis and how to treat it.

Understanding the shoulder.

The shoulder joint is made up of three bones:  

The humerus (long bone in the upper arm), the clavicle (collar bone) and scapula (the shoulder blade) with connective tissues that make up your shoulder capsule.  Inside this capsule is synovial fluid which is a fluid that lubricates the bones and connective tissue.

Who gets adhesive capsulitis?

Most commonly adhesive capsulitis occurs in 40-60 year olds and more often women.  People with diabetes or thyroid conditions are at increased risk of getting adhesive capsulitis.   Other medical conditions increase your risk of adhesive capsulitis as well, like stroke and Parkinson disease.  

You can also get secondary adhesive capsulitis which occurs after shoulder injuries like rotator cuff tears, proximal humerus fractures or shoulder surgery.   

What causes adhesive capsulitis?  

While the cause is not fully understood, a common thought is inflammation in the shoulder joint capsule which then leads to the development of adhesion and fibrosis in the synovial lining.  This causes the shoulder joint to thicken and contract leading to restricted range of motion.

What are the symptoms of adhesive capsulitis?

Most experience a stiff and painful shoulder.  They will have trouble reaching overhead and behind the back.   With this pain some patients will experience weakness in the joint, as well.  

What are the stages of adhesive capsulitis?

1st stage / Freezing: diffuse, severe and disabling pain in the shoulder with increasing stiffness. This phase can last 2-9 months.  

2nd stage / Frozen: stiffness and severe loss of shoulder motion but pain is gradually decreasing.  This phase lasts 4-12 months

3rd stage / Thawing: recovery with gradual return of motion.  This can take 5 to 24 months.

Adhesive capsulitis affects only one shoulder at a time and can resolve on its own in two to three years or longer.   Due to the significant impact of joint function and discomfort caused by adhesive capsulitis most people seek treatment to drastically reduce the length of time for recovery.

How do you diagnosis adhesive capsulitis?

When seeing an orthopedic surgeon we can diagnose adhesive capsulitis with a physical exam.  Most patients present with pain and significantly reduced active and passive range of motion.  X-rays are beneficial to rule out other shoulder conditions like shoulder osteoarthritis which can mimic symptoms of adhesive capsulitis.  We can use Musculoskeletal ultrasound to see thickening of the joint capsule, increased fluid in the joint and rule out any rotator cuff tear.  

What is the treatment of adhesive capuslitis?

First step:  

  • Prednisone
  • Cortisone injection
  • Physical therapy

Nonsteroidal anti-inflammatory drugs (NSAIDs), prednisone dose pack or shoulder joint injection with corticosteroid and physical therapy.  The NAIDs or steroid and prednisone dose pack will decrease the inflammation in the joint and physical therapy is to break up the adhesions that have formed to get full range of motion back.   This treatment is given 3-4 weeks to work.

Second step:

If there is no improvement or minimal improvement with the first step, the next course of action is a closed manipulation by an orthopedic surgeon.  This is an outpatient procedure; the orthopedic surgeon moves your shoulder through full range of motion to break up the adhesions and then injects the shoulder with a steroid.  After the procedure physical therapy is prescribed to prevent the adhesions from reoccurring.

If you or a loved one is experiencing shoulder pain, contact Dr. Timothy Hamby at Tristate Orthopaedics.  Contact information is below along with a link to schedule an appointment.

Please call to schedule an appointment:  812.477.1558

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