Adhesive Capsulitis (Frozen Shoulder)

A Type of Shoulder Pain

 Frozen shoulder (adhesive capsulitis) is a condition where increasing pain and stiffness are experienced in an adult patient’s shoulder. Frozen shoulder can occur for no obvious reason (idiopathic), or it can follow trauma or surgery to the shoulder, chest or breast. It is more common in patients who also have diabetes, heart disease, thyroid disease, high cholesterol, stroke, and Dupuytren’s disease. Frozen shoulder is usually broken up into 3 overlapping stages which can span up to 24 months:

1. Freezing Stage of Frozen Shoulder: 0-12 months
The shoulder is becoming increasingly painful and stiff. There may or may not have been a traumatic onset which “triggered” the pain in the shoulder. Classically, aggressive physiotherapy makes the shoulder pain and stiffness worse. The inflamed shoulder joint becomes more inflamed with the increased demands place upon it. The shoulder loses motion in all directions but this can be difficult to differentiate from shoulder impingement in the early stages of the disease.

2. Frozen Stage of Frozen Shoulder: 6-18 months
The pain in the shoulder begins to settle, but the shoulder is now very stiff in all planes (global stiffness) classically lacking external rotation and forward elevation. There is some loss of function, particularly with overhead activities but most people are able to cope with the reduced function provided by their shoulder.

3. Thawing Stage of Frozen Shoulder: 12- 24 months
The shoulder gradually regains it’s range of motion with the help of physiotherapy and, if needed, arthroscopic surgery.
A recent study* reported that the chance of achieving a pain free and functional range of motion is approximately 70%. In diabetics, there is a 20% chance of the condition occurring bilaterally (in both shoulders). There are numerous treatments described which classically depend on the stage of the disease:

1. Freezing Stage: This stage is best treated with rest, analgesics (pain killers), and activity modification. In some people an injection into the shoulder joint can provide short term pain relief.

2. Frozen stage: This stage often does not respond to physiotherapy and a wait wand see approach works best. Some patients are able to tolerate physiotherapy to progressively achieve an increased range of motion. If gains are not being made with physiotherapy, then consideration may be given to an arthroscopic capsular release (which involves clearing all the scar tissue in the shoulder joint to free up motion) and manipulation under anaesthetic to assist the regaining of a functional range of motion. Hydrodilatation can also be considered (see below)

3. Thawing stage: This stage is best treated with ongoing physiotherapy- once again, if gains are not being made then consideration can be given to an arthroscopic capsular release.

Numerous treatments are described in the literature, including injections of cortisone into the shoulder joint and rupturing the shoulder joint with fluid (hydrodilatation). But have different results when reported by different authors. The mainstay of treatment is adequate analgesia, activity modification, and graded physiotherapy in the stiff but less painful stages of the disease.

If you feel like you are suffering from frozen shoulder it is recommended you consult your Doctor for a proper diagnosis. There are other conditions which can present with similar symptoms and which may require more urgent treatment (e.g. infection) or are more amenable to treatment (e.g. shoulder arthritis).

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*Long-term outcome of frozen shoulder. Hand et al, J Shoulder Elbow Surg, 2008; 17:231-236