What is adhesive capsulitis?

Adhesive capulitis is the technical term for "Frozen Shoulder." The shoulder joint is supported by ligaments which connect the shoulder bones together and keep them properly aligned when in motion. Normally, the ligaments are flexible enough to permit full movement of the shoulder. When adhesive capsulitis occurs, the ligaments develop an inflammatory process, with scar tissue formation that limits motion and causes pain. This "freezing" of the joint severely decreases the shoulder's normal range of motion and can cause a considerable amount of pain when motion is attempted.

Who is most at risk?

Women 40 years of age and older are most likely to develop frozen shoulder. Some medical conditions, such as diabetes or cardiovascular diseases can be associated with frozen shoulder, but the condition can occur without any other predisposing medical conditions. Some women can also develop adhesive capsulitis after breast surgery. Men can also develop this condition, although much less commonly.

How do symptoms develop?

Adhesive capsulitis progresses through three general phases. The symptoms of the first phase, or "freezing phase", include the insidious onset of generalized pain around the shoulder which leads to decreased movement of the shoulder. It is felt that because of the pain resulting from the inflammation, the patient doesn't move the shoulder, thereby setting the stage for the scar tissue to form that restricts the shoulder even more. The second phase, or "frozen phase", is distinguished by localized pain and tenderness about the humeral head, and discomfort that seems to worsen at night and often interferes with sleep. During this phase, the inflammation is slowly decreasing and the scare tissue is maturing. The final phase, or "thawing phase", brings a less painful shoulder but still with a significantly decreased range of motion. During this phase, the scar tissue may begin loosening up and shoulder motion may slowly return.

Do all calcium deposits cause pain?

Many calcium deposits are present for years without causing any symptoms. Only when the deposit becomes large enough to pinch between the bones when the shoulder is elevated, does it cause pain. Sometimes smaller deposits cause pain if they become acutely inflammed, especially when the calcium salts leak from the lesion into the sensitive bursal tissues.

How is a diagnosis of adhesive capsulitis made?

The diagnosis of frozen shoulder is usually made by an orthopedic surgeon. The symptoms of shoulder pain are often confused with such things as calcific bursitis, rotator cuff tears, arthritis, or tendinitis. Although these more serious conditions are thought to sometimes precede adhesive capsulitis, in most cases that is not necessarily true and the condition is an isolated event. When the surgeon notices a decrease in shoulder motion, particularly in flexion and rotation, the diagnosis should be considered. When x-rays, MRI, and physical exam rule out other causes of pain, then the diagnosis is confirmed.

How is adhesive capsulitis treated?

The treatment of adhesive capsulitis depends on the stage and severity of the condition. Often in the early stages, oral anti-inflammatory medicines are helpful to decrease joint inflammatory reaction and scar tissue formation. In addition, physical therapy modalities, including phonophoresis, ultrasound, and hot and cold treatment can be helpful. A physical therapist who is familiar with this condition is also very helpful in performing active-assisted and passive gentle manipulative range of motion activities. Frequently this is best done in a warm thapy swimming pool. A home exercise program, using an overhead pulley and stretching activities with a cane or wand, must be included in the therapy program.

Pain medicines are often necessary to help with the discomfort, particularly during the "frozen phase". Nonnarcotic medicines are preferable since thse medicines may need to be taken for several months.

Surgery for adhesive capulitis is sometimes necessary when patients fail to make progress with physical therapy and shoulder pain continues. Initially, a manipulation under anesthesia can be performed on an outpatient basis. With the patient asleep, the surgeon carefully manipulates the shoulder through a full range of motion and tries to loosen the tight scar tissue that restricts the shoulder motion. It is sometimes necessary to perform an arthroscopic evaluation of the shoulder to further release additional adhesions in more severe cases. Following manipulation, the patient resumes phycial therapy. On occasion, two or even three manipulations may be required since the adhesions can reform if the inflammatory process remains active.

What is long-term outlook on frozen shoulder?

Most cases of frozen shoulder eventually resolve, either spontaneously, or following physical therapy and/or manipulation. This condition does not lead to arthritis or rotator cuff tendon damage. Despite the fact that the shoulder is considerably disabled for a prolonged period of time, within two years most cases of adhesive capsulitis have resolved. This is the most important thing for a patient to realize. The condition very rarely returns to a joint once it has resolved.

Who can I call for more information?

Please feel free to contact us and ask one of our physicians for a referral. We will be happy to answer your questions and evaluate your shoulder in the Clinic.

Don Buford, M.D. © 2008