What is Frozen Shoulder? – Adhesive Capsulitis


Does Your Shoulder Feel Stiff?

Adhesive capsulitis commonly referred to as the “frozen shoulder,” is a musculoskeletal condition that occurs when your shoulder joints become inflamed followed by the development of scar tissue. This buildup of scar tissue along the lining of the joints prevents easy motion of the shoulder and causes stiffness and pain during movement.

3 phases to know:

  • Phase 1 (2 to 9 months): severe and disabling shoulder pain that is worse at night and leads to increasing stiffness

  • Phase 2 (4 to 12 months): severe loss of shoulder motion and gradual decrease in pain

  • Phase 3 (5 to 24 months): the gradual return of range of motion

Why is it important to know?

Adhesive capsulitis is more commonly seen in women ages 40-60. Individuals with diabetes are at higher risk, and often have a more prolonged course, and are more resistant to therapy. 10 to 20% of people with adhesive capsulitis develop a long-term disability and 30 to 60% report persistence of symptoms.

How do we diagnose adhesive capsulitis?

Diagnosis is primarily clinical and involves a reduction in active (when the patient is moving the arms) and passive (when the physician is moving the patient’s arms) range of motion in 2 or more planes of motion. Sometimes, an injection test is done to distinguish from other musculoskeletal conditions with similar clinical manifestations (ex. subacromial conditions).

What is management?

Frozen shoulder is typically a self-limiting condition with high rates of spontaneous recovery within 18 to 30 months. Therefore, management is most often limited to symptomatic relief and improving range of motion through various exercises and integrative medicine modalities, including osteopathic manipulative therapy. Patient education is also important. If the condition does not improve with symptomatic management, then oral or intralesional glucocorticoids can be given. Surgery is only reserved for refractory cases.

Conclusion

Some complications to be aware of include residual shoulder pain and/or stiffness, humeral fracture, and rupture of the biceps and subscapularis tendons. However, early diagnosis leads to a favorable outcome so don’t wait too long to go to the doctor!