What is Adhesive Capsulitis
Also known as “frozen shoulder”, adhesive capsulitis is characterized by pain, loss of motion of the shoulder joint, and normal radiographic (X-ray) findings. Adhesive capsulitis is usually considered “idiopathic”, which means it is not fully understood why it happens. There are predisposing factors to developing a frozen shoulder, including diabetes or impairment in blood sugar metabolism, trauma or fracture, prior surgery, hyperthyroidism, and neurologic conditions including neck/cervical spine disease or Parkinson’s disease. Often times, however, these factors are not present and the condition just happens or may result from irritation after a fall or a traumatic injury. Adhesive capsulitis affects females more than males and most commonly between the ages of 40 and 65. The common denominator in all cases of frozen shoulder is an inflammatory reaction where the body mounts a response to the otherwise normal tissue around the shoulder, specifically the tissue called the capsule which is a sheath of tissue that covers the ball-and-socket joint of the shoulder. This inflammation of the capsule causes pain, limitation of motion, and eventually difficulties with function of the arm.
What Are the Findings in Adhesive Capsulitis?
As noted above, the primary symptoms of adhesive capsulitis is pain. The shoulder hurts, and motion may become painful for many otherwise ordinary activities. Lifting the arm overhead, reaching across the body, reaching a bra or behind the back become increasingly difficult or impossible.
The evaluation of a frozen shoulder typically starts with radiographs, which are characteristically normal. Although these films are normal in this disease, they are an important part of the evaluation because it helps to exclude other problems in the shoulder joint, such as osteoarthritis, calcific tendonitis, and deformities of the shoulder bones. The problem is in the soft tissue, and although MRI is helpful to screen for conditions that may also be present, the MRI is not always needed.
Frozen shoulder is diagnosed by a careful physical examination where the motion of the shoulder is noted to be limited. There is a limitation of not only active motion (which is the range of motion the patient can produce on their own will) but also passive motion (where the examiner cannot move the joint any further than the patient can). The limits of motion are very painful and just stretching the shoulder for the examination can be uncomfortable. Although this can cause pain, a thorough physical examination is critical because without the examination, the condition can be missed.
What Is the Treatment for Adhesive Capsulitis?
The initial treatment for frozen shoulder depends on several factors which may be unique to the patient and individualized for the individual circumstances of the case. Severe cases with substantial motion loss can benefit in the early stages (or first visit) with a cortisone injection, which is a powerful anti-inflammatory and cuts down the irritation and pain. This is only temporary, however, and the benefit of the cortisone is best achieved with a vigorous course of exercises called “terminal stretches” where the shoulder is pushed to the limits of tolerable motion and held there, so as to stretch the capsule tissue of the shoulder. This stretching program can be very painful, and the cortisone helps to limit the discomfort, coupled with heat and ice used strategically. Also helpful is an evaluation and treatment by a physical therapist, who is trained to guide the patient through exercises that specifically target the inflamed capsule tissue in the shoulder and to teach the patient home exercises while the patient stretches the shoulder on his or her own.
Cases of frozen shoulder that are persistently painful, not responsive to initial stretching treatment, or are an ongoing cause of functional impairment may be amenable to an arthroscopic procedure called a release, where the abnormal tissue in the shoulder is released in a minimally invasive fashion (with the “scope”), which frees the tissue so the shoulder immediately regains the range of motion. Following this procedure, the patient is instructed to work diligently with a physical therapist to continue stretches to continue to maintain the motion achieved during the procedure. While there are other procedures described for frozen shoulder such as a manipulation under anesthesia (MUA) where the patient is put to sleep and the shoulder forcefully manipulated to restore motion, this procedure has a higher rate of complications including tendon or other soft tissue injury and bone fracture and therefore has largely been replaced with more specific and modern arthroscopic techniques.
Schedule an orthopedic appointment
If you have pain in your shoulder and are concerned you may require an orthopedic subspecialist evaluation, call our office, or book an appointment with shoulder surgeon Dr. Thomas Obermeyer. Dr. Obermeyer provides expert orthopedic care for patients suffering Adhesive Capsulitis. Dr. Obermeyer has orthopedic offices in Schaumburg, Bartlett, and Elk Grove Village, Illinois. Dr. Obermeyer regularly sees patients from throughout Illinois including Hoffman Estates, Palatine, Elgin, Streamwood, Arlington Heights, and Roselle communities.
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Dr. Thomas Obermeyer
- 15+ years of training and experience treating complex shoulder and sports medicine conditions
- Expert subspecialized and board-certified orthopedic care
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