Adhesive Capsulitis ( Frozen Shoulder ) A Guide for Patients

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1 Adhesive Capsulitis ( Frozen Shoulder ) A Guide for Patients Anil K. Gupta, MD, MBA Sports Medicine and Shoulder Surgery Toledo Orthopaedic Surgeons 1

2 Frozen Shoulder Frozen shoulder, also called adhesive capsulitis, causes pain and stiffness in the shoulder. Frozen shoulder occurs in about 2% of the general population. It most commonly affects people between the ages of 40 and 60, and occurs in women more often than men. It is commonly seen in diabetics or in the post-traumatic setting. Anatomy The shoulder is a ball-and-socket joint made up of three bones: humerus, scapula, and clavicle Strong connective tissue, called the shoulder capsule, surrounds the joint (Figure 1) Description of Condition Figure 1 Figure 2 The shoulder capsule thickens secondary to inflammation (Figure 2). Stiff bands of scar tissue, called adhesions, develop. The key symptoms with the condition are pain and stiffness. It develops in three stages: o Freezing Patients develop gradual increase in pain and stiffness. This phase can last from 6-9 months. o Frozen Pain often improves, but the stiffness remains. Stiffness and functional loss may peak during this stage. o Thawing Shoulder motion slowly improves. Complete return to normal or close to normal strength and motion can take from 6 months to 1 year. Causes The causes of frozen shoulder are not fully understood. Some factors may patients at risk include : o Diabetes - Frozen shoulder affects 10% to 20% of these individuals. The reason for this is not known. o Other diseases - hypothyroidism, hyperthyroidism, Parkinson's disease, and cardiac disease. o Immobilization - Frozen shoulder can develop after a shoulder has been immobilized for a period of time due to surgery, a fracture, or other injury. 2

3 Physical Examination Figure 3 The hallmark examination finding is loss of active and passive range of motion with pain. Passive range of motion is when Dr. Gupta moves your shoulder (Figure 3). Active range of motion is when you move your shoulder on your own. Imaging Tests Dr. Gupta may order imaging tests to look for a associated conditions: o XRay Typically performed to evaluate for arthritis o MRI Best study to evaluate for associated soft tissue disease, such as a rotator cuff tear. Treatment Frozen shoulder generally gets better over time, although it may take 1-2 years. The focus of treatment is to control pain and restore motion and strength through stretching exercises. Nonsurgical Treatment The majority of patients respond well to non-operative measures Non-steroidal anti-inflammatory medicines - Drugs like ibuprofen or a Medrol dose pack reduce inflammation. Steroid injections - Cortisone is a powerful anti-inflammatory medicine that is injected directly into your shoulder joint. Depending on the severity of the condition, Dr. Gupta may recommend this treatment measure. Physical therapy A program under the supervision of a physical therapist or via a home program. Therapy includes stretching or range of motion exercises for the shoulder. Below are examples of some of the exercises that you should perform at least twice per day. You should feel mild (NOT severe) pain while performing the stretches. External rotation passive stretch. Stand in a doorway and bend your affected arm 90 degrees to reach the door frame. Keep your hand in place and rotate your body as shown in the illustration. Hold for 30 seconds. Relax and repeat. 3

4 Forward flexion supine position. Lie on your back with your legs straight. Use your unaffected arm to lift your affected arm overhead until you feel a gentle stretch. Hold for 30 seconds. Relax and repeat.. Crossover arm stretch. Gently pull one arm across your chest just below your chin as far as possible without causing pain. Hold for 30 seconds. Relax and repeat. Sleeper Stretch Lie on your side. Use your normal arm/hand to gently push down on the affected arm. Hold this stretch for 30 seconds. Relax and repeat. Surgical Treatment Surgery treatment is reserved for patients with persistent pain, loss of motion, and dysfunctions despite conservative treatment. The goal of surgery is to release the stiffened joint capsule. The most common methods include manipulation under anesthesia and shoulder arthroscopy. Manipulation under anesthesia - During this procedure, you are put to sleep. Dr. Gupta will apply gentle pressure to the shoulder in different directions. This releases the adhesions and increases range of motion. Shoulder arthroscopy - In this procedure, Dr. Gupta releases the capsule using special arthroscopic instruments. This is often combined with a manipulation under anesthesia. Most patients have very good outcomes with these procedures with relief of pain and restoration of motion and function. 4

5 Normal shoulder capsule Inflamed and fibrotic capsule Released capsule Recovery you will start moving your shoulder the day of surgery. Physical therapy and a daily home exercise program are necessary to maintain the motion that was achieved with surgery. Recovery times vary, from 6 weeks to three months. Although it is a slow process, your commitment to therapy is the most important factor in returning to all the activities. o Long-term outcomes after surgery are generally good, with most patients having reduced or no pain and greatly improved range of motion and restoration of function. In some cases, however, even after several years, the motion may not return completely and a small amount of stiffness remains. o Although uncommon, frozen shoulder can recur, especially if a contributing factor like diabetes is still present. Sources of Above Information: Additional Resources Regarding Dr. Gupta: gupta- md- mba/7b/36/bb8 5

Frozen shoulder, also called adhesive capsulitis, causes pain and stiffness in the shoulder. Over time, the shoulder becomes very hard to move.

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