Frozen Shoulder (Adhesive Capsulitis) Symptoms & Surgery
The exact cause of the condition is unknown, however, it usually starts spontaneously. At other times there may be an initiating event such as an injury or surgery to the shoulder.
It usually occurs from middle age onwards and is very common in people with diabetes and in women. Often both shoulders are affected, separated by a short period of time.
Although the underlying cause is unknown the abnormalities noted are a profound inflammation of the lining of the shoulder joint and subsequent scarring and tightening of the ligaments and capsule surrounding the shoulder joint. The inflammation results in pain, and the scarring reduces movement.
Causes & Symptoms
Whilst the exact cause of a frozen shoulder is not known, the joint capsule often becomes inflamed and symptoms associated with this condition then usually develop gradually over time. It can, however, also develop following a recent history of minor or serious shoulder injury, surgery and/or period of immobilisation.
Patients typically experience a dull ache that may increase to a sharper pain with certain movements or activities. Pain tends to be focused deep in the shoulder, however, it may occasionally be experienced in the upper arm, upper back and neck and you may also experience stiffness in each of these regions.
Patients also typically experience stiffness and significantly reduced range of movement of the shoulder, particularly with motions required for grooming, performing overhead activities, dressing, and reaching behind the back or for the seatbelt. You may also experience pain at night or upon waking in the morning.
As the condition progresses, it often presents three distinct phases. They are the inflammatory phase (freezing phase), stiffness phase (or frozen phase), then a resolution or 'thawing' phase. Each phase may last for months, and studies have shown complete resolution can take 8-40 months.
The diagnosis of frozen shoulder is largely a clinical diagnosis. The onset of pain and symptoms often follows a characteristic pattern. Clinical examination is also extremely valuable. During the physical exam, your doctor may ask you to move in certain ways to check for pain and evaluate your active range of motion. Your doctor might then ask you to relax your muscles while he or she moves your arm (passive range of motion). Frozen shoulder affects both your active and passive range of motion as there is a significant restriction in the shoulder’s range of motion created by a contracture in the shoulder capsule itself. Often the patient notices this as a loss of motion in rotational movements.
Although the diagnosis is largely clinical, your doctor may suggest some tests like x-ray, ultrasound or MRI to rule out other problems.
Most frozen shoulder treatment involves controlling shoulder pain and preserving as much range of motion in the shoulder as possible.
Over-the-counter pain relievers, such as aspirin and ibuprofen, can help reduce the pain and inflammation associated with frozen shoulder. In some cases, you may be prescribed stronger pain-relieving and anti-inflammatory drugs. Although these may well help your symptoms, they may not in isolation limit the length of this syndrome.
A physical therapist can teach you range-of-motion exercises to help you recover as much mobility in your shoulder as possible. Your commitment to doing these exercises is important to optimise recovery of your mobility. This can, however, in some instances not be possible or indeed be counter-productive, particularly in the initial phases of this condition where pain is a significant feature. Physical therapy is extremely helpful in conjunction with other treatment modalities to maximise and maintain the effect of regaining range of motion.
Surgical and other procedures
Although many frozen shoulders get better on their own within 12 to 18 months, the sufferer can have very significant pain and sleep disturbance. For persistent symptoms, your consultant specialist may suggest:
Steroid injections- Injecting corticosteroids into your shoulder joint may help decrease pain and improve shoulder mobility, especially in the early stages of the process.
Joint distension- Injecting sterile water into the joint capsule can help stretch the tissue and make it easier to move the joint. Often this is combined with a steroid injection.
Surgery- Surgery for frozen shoulder is rare, but if nothing else has helped, your consultant may recommend surgery to remove scar tissue and adhesions from inside your shoulder joint. This is usually extremely effective in helping resolve pain and regain range of motion. This procedure is performed arthroscopically (keyhole surgery).
Aftercare & Recovery
Following treatment with any of the described treatment options, physical therapy is essential to maintain the gains and maximise the range of motion you have achieved. Patients are encouraged to follow a self-directed rehabilitation program, initially aimed at increasing range of motion and preventing further capsular constriction. This will be helped by supervision of a physiotherapist.