Frozen Shoulder (Adhesive Capsulitis)

Frozen shoulder is a slowly progressive, painful process that happens when the connective tissues and joint capsule surrounding the shoulder joint thicken and tighten. This condition is also known as adhesive capsulitis due to the adhesions that result from scar tissue. This thickening can cause pain and stiffness of the shoulder and contribute to a loss of shoulder and arm movement. In some cases, there is a complete loss of shoulder mobility making simple daily tasks painful and difficult. There are 3 main categories of frozen shoulder:

• Primary Idiopathic Frozen Shoulder– which means it just happens spontaneously without a specific reason

• Secondary Frozen Shoulder – which means that it occurs in response to another problem in the shoulder

• Post Traumatic – which means that it develops after an acute injury to the shoulder or sometimes following shoulder surgery

While the cause of frozen shoulder is not well understood, some risk factors do exist. Frozen shoulder most commonly occurs in women aged 40-60 years old. 40-50% of patients who develop frozen shoulder on one side, will get a frozen shoulder on the other side at some point. Diabetes is a major risk factor and 10-20% of patients with diabetes will develop a frozen shoulder at some point during their lifetime. Other general risk factors include thyroid disease, high cholesterol, COPD, osteopenia, Dupuytren’s disease, and coronary artery disease. Shoulder immobilization because of another injury to the shoulder or same arm can also increase the risk of developing a frozen shoulder. Some injuries to the shoulder itself can start the process of inflammation leading to a frozen shoulder. Frozen shoulder is a very frustrating condition for both patient and surgeon because it often takes a long time to resolve.

Phases of Frozen Shoulder

Frozen shoulder develops in 3 phases over a period of time. Early recognition of the problem helps get treatment started quickly and can reduce the time course of the condition.

• Freezing: There is a gradual increase of pain and decrease of shoulder motion that can last up to 9 months

• Frozen: The pain is decreased, but daily activities become very difficult, as range of motion is very limited. This can last up to 6 months

• Thawing: Shoulder motion improves slowly over a period that can last up to 24 months

Diagnosis & Treatment

Frozen shoulder is diagnosed using physical examination and imaging studies may be needed to rule out other conditions. The physical examination is used to identify areas of pain and carefully quantify range of motion of the shoulder. Treatment of frozen shoulder can be done with non-surgical or surgical means. The goal of treatment is to reduce pain and regain function of the shoulder. Non-surgical treatment is successful in 90% of patients. These therapies are used to reduce inflammation associated with injury and allow you to strengthen the rotator cuff muscles and regain function. Non-surgical treatment options include:

• Non-steroidal anti-inflammatory medications (NSAIDs) can help decrease inflammation

• Injections: Steroid injections can help decrease inflammation in the shoulder joint and are performed using ultrasound guidance. There is currently little evidence supporting the use of biologic injections for shoulder impingement, but this is an area of increased scientific study.

• Physical therapy: This is an important tool to help you strengthen and retrain the muscles of the rotator cuff to work better together

Surgery may be required if prolonged conservative treatment is not successful. Surgical treatments can include:

• Shoulder arthroscopy with manipulation under anesthesia cuts bands of thickened capsule and then moves the shoulder in a controlled fashion while you are under anesthesia to free the shoulder from its tightened restrictions and allow for normal range of motion

Postoperative physical therapy is critical to maintaining the range of motion that we regain from surgical treatment in the OR.