Treatment for Frozen Shoulder (Adhesive Capsulitis)

What is it?

Adhesive capsulitis or frozen shoulder is a relatively common ailment of the shoulder which causes pain and loss of motion. Frozen shoulder is caused by a thickening of the shoulder capsule, the tissue which lines the shoulder joint. When this tissue thickens and contracts, it can result in pain and loss of motion. Frozen shoulder is more common in females and patients of middle age, but it can affect anyone. It can be a frustrating ailment for a patient to deal with as it can affect daily function and sleep.

What causes frozen shoulder?

The exact cause of frozen shoulder is not precisely known. However, in general, most frozen shoulder can be thought of as an exuberant inflammatory response within the shoulder. Inflammation is the body's normal response to injury, however, in patients with frozen shoulder this inflammation persists longer than normal resulting in thickening and contracture of the capsule and ligaments. Diabetic patients and patients with hypothyroidsm are more prone to developing the disease. Additionally, if can result from secondary causes such immobilization after a fracture or shoulder injury.

What if conservative measures fail?

If therapy and other conservative measures fail to provide adequate relief and restoration of motion, then sometimes surgery can be considered. In general, greater than 90% of patients with lateral epicondyltis can avoid surgery with a combination of non-surgical methods.

Surgery is performed arthroscopically and the capsule is surgically released circumferentially. Following the surgery, immediate post-operative therapy and range of motion exercises are initiated. This includes stretching every hour while awake to maintain the motion gains achieved at surgery.

What are the risks of surgery?

Surgery for frozen is typically very safe. It is a procedure performed through a small incision around the shoulder and using a camera to visualize the joint. Other than general surgical risks and anesthetic risks, specific risks include:

  • Recurrance of stiffness
  • Prolonged rehab
  • Nerve injury

How do I know if I have a frozen shoulder?

Patients with a frozen shoulder typically have painful restriction of movement in all planes of motion without the presence of other diseases that cause motion loss such as arthritis. The motion remains restricted even when someone else moves the arm and can be associated with pain at the end-ranges of motion when the capsule is stretched. X-rays will need to be taken to ensure that there are not other causes for motion loss. Occasionally an MRI can be ordered, but typically this is not needed to make the diagnosis. If x-rays do not demonstrate any significant abnormalies, physical examination can confirm findings of frozen shoulder.

How is it treated?

The vast majority of frozen shoulders can be managed without surgery. However, it can take many months of treatment to attain complete relief. The goals of treatment are to break the cycle of inflammation in the shoulder and to gradually stretch out the capsule and ligaments. Below are some common methods used to achieve this.

Rest and activity modification: Avoiding activities that aggrevate the shoulder joint. This usually means avoiding overhead activities or heavy use of the shoulder.

Anti-inflammatories: Since frozen shoulder results from inflammation, anti-inflammatories (naproxen or ibuprofen) can be helpful. However, you must watch out for stomach irritation and it is not recommended for patients with kidney dysfunction.

Physical Therapy: PT is aimed at stregthening and stretching the capsule of the shoulder. This is the mainstay of treatment for frozen shoulder. Patients should stretch their shoulder as much as possible throughout the day. It is nearly impossible to stretch a frozen shoulder too much.

Injections: Steroid injections can be used if other conservative measures are unsuccessful. Usually it is our preference to reserve this for patients who have not seen much progress with an initial attempt with physical therapy.