Adhesive Capsulitis (Frozen Shoulder)

A condition causing pain and stiffness in the shoulder joint

What is Adhesive Capsulitis?

Adhesive capsulitis, commonly known as frozen shoulder, is a condition characterized by stiffness and pain in the shoulder joint. It occurs when the shoulder capsule (the connective tissue surrounding the shoulder joint) becomes thick and tight, limiting the shoulder's range of motion. The condition typically develops gradually, worsens over time, and then slowly improves, usually taking 1-3 years to fully resolve.

Common Symptoms

Adhesive capsulitis can cause various shoulder and surrounding area symptoms:

Stages of Frozen Shoulder

Stage 1: Freezing (Painful Stage)

Duration: 6 weeks to 9 months

Progressive onset of shoulder pain, especially at night. Range of motion gradually decreases. Pain is often the primary complaint during this stage.

Stage 2: Frozen (Stiffness Stage)

Duration: 4 to 12 months

Pain may decrease, but stiffness increases significantly. Shoulder movement becomes severely limited. Daily activities become very difficult.

Stage 3: Thawing (Recovery Stage)

Duration: 12 to 42 months

Gradual improvement in range of motion. Pain continues to decrease. Strength slowly returns, though some people may have lasting limitations.

Common Causes and Risk Factors

Primary (Idiopathic) Frozen Shoulder

  • Unknown cause: No clear underlying condition identified
  • Age: Most common in people aged 40-60
  • Gender: More common in women than men
  • Genetics: May have familial tendency

Secondary Frozen Shoulder

  • Diabetes: Significantly higher risk, affecting up to 20% of diabetics
  • Thyroid disorders: Both hyperthyroidism and hypothyroidism
  • Shoulder injury: Rotator cuff tears, fractures, or surgery
  • Prolonged immobilization: Extended periods of shoulder inactivity
  • Cardiovascular disease: Heart disease or stroke
  • Parkinson's disease: Neurological conditions affecting movement
  • Autoimmune conditions: Rheumatoid arthritis or other inflammatory diseases

Diagnosis

Adhesive capsulitis is typically diagnosed through:

  • Physical examination: Assessment of range of motion and pain patterns
  • Medical history: Review of symptoms, onset, and progression
  • Range of motion tests: Measuring active and passive shoulder movement
  • X-rays: To rule out arthritis or other bone problems
  • MRI: May show thickened joint capsule and rule out rotator cuff tears
  • Arthrogram: Injection of contrast dye showing reduced joint volume

Treatment Options

Conservative Treatment

  • Physical therapy: Gentle stretching and range of motion exercises
  • Heat and cold therapy: To reduce pain and inflammation
  • NSAIDs: Anti-inflammatory medications for pain relief
  • Activity modification: Avoiding movements that worsen pain
  • Home exercises: Gentle stretching program

Medical Interventions

  • Corticosteroid injections: Anti-inflammatory injections into the joint
  • Oral corticosteroids: Short-term use for severe inflammation
  • Hydrodilatation: Injection of fluid to stretch the joint capsule
  • Nerve blocks: Suprascapular nerve blocks for pain relief

Surgical Options

  • Manipulation under anesthesia: Forceful movement of the shoulder while asleep
  • Arthroscopic capsular release: Surgical cutting of tight portions of the joint capsule
  • Open surgical release: Traditional surgery for severe cases

Recommended Exercises

Gentle Range of Motion Exercises

  • Pendulum swings: Let arm hang and gently swing in circles
  • Wall walks: Use fingers to "walk" up a wall
  • Cross-body stretches: Gently pull arm across the chest
  • External rotation: Using a towel or stick for assistance
  • Behind-the-back stretches: Gentle reaching behind the back

Important Exercise Guidelines

  • Start slowly and gradually increase range of motion
  • Never force movements that cause severe pain
  • Consistency is more important than intensity
  • Heat before exercising, ice after if needed
  • Work with a physical therapist for proper technique

When to See a Healthcare Provider

Seek medical attention if you experience:

  • Severe shoulder pain that interferes with sleep
  • Significant loss of shoulder movement
  • Inability to perform daily activities
  • Symptoms that worsen despite home treatment
  • Signs of infection (fever, warmth, redness)
  • Sudden onset of severe shoulder pain
  • Numbness or tingling in the arm or hand

Potential Complications

  • Permanent stiffness: Some people may have lasting range of motion limitations
  • Muscle weakness: From prolonged disuse of the shoulder
  • Compensatory problems: Neck, back, or opposite shoulder issues
  • Recurrence: Can occur in the same or opposite shoulder
  • Depression or anxiety: From chronic pain and disability

Prevention

  • Maintain good diabetes control if diabetic
  • Keep shoulders mobile with regular gentle exercises
  • Avoid prolonged shoulder immobilization when possible
  • Treat shoulder injuries promptly and properly
  • Maintain good posture to prevent shoulder problems
  • Stay physically active within your limitations
  • Follow up regularly with healthcare providers for underlying conditions

Prognosis

The outlook for adhesive capsulitis varies:

  • Natural progression: Most cases improve over 1-3 years
  • Recovery rate: 90% of people regain near-normal function
  • Residual symptoms: Some may have mild, persistent stiffness
  • Diabetic patients: May have slower recovery and more complications
  • Early treatment: May help reduce duration and severity

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