UW Health's Sports Medicine doctors treat a wide range of common athletic injuries, including adhesive capsulitis - a loss of motion in the shoulder.
About Adhesive Capsulitis
Adhesive capsulitis is a term used to describe a significant loss of range of motion in all directions in the shoulder joint, which also may be referred to as "frozen shoulder." This is a condition where the shoulder capsule becomes contracted and thickened. The early stages of frozen shoulder are often quite painful.
The loss of motion is apparent when attempting to move the shoulder, as well as when someone else attempts to move the shoulder and the muscles are relaxed. The cause of adhesive capsulitis is unknown; however it is well-known that this does not occur in any other joints of the body and is not the result of rotator cuff injuries, arthritis or labral injuries.
- Women between the ages of 30-60
- Individuals with diabetes (10-20 percent)
- May be associated with the following conditions: hypothyroidism, hyperthyroidism, Parkinson’s disease, cardiac disease or surgery
- There is usually no true cause of why this occurs, but it can occur after a minor shoulder injury or a period of immobilization
Signs and Symptoms
- Dull, achy pain that increases when attempting shoulder motion
- Pain located in the shoulder area and/or upper arm
- Restricted motion or stiffness
In order to diagnose this condition, the medical providers will perform a physical exam of the involved area. The physical exam may include tests of movement and strength. In addition, x-rays may be needed to assess the alignment and cartilage spaces of the involved joint or to rule out other potential bone abnormalities. Further imaging, such as an MRI, is rarely indicated but may be performed if there is concern of injury to the tendons, ligaments and joint if initial treatment does not improve symptoms.
Course of Adhesive Capsulitis
- Phase 1 (Freezing): increased pain, decreased range of motion
- Phase 2 (Frozen): decreased pain, decreased range of motion
- Phase 3 (Thawing): pain has significantly decreased, motion improves over time
Treatment Option: Conservative
The primary areas of focus are for pain control and restoration of motion. About 95 percent of patients notice significant improvement over time, even without treatment. Although resolution may take up to two years, with appropriate treatment this time frame usually can be reduced. Appropriate treatment should match the stage of adhesive capsulitis.
- Freezing Stage (approximately six weeks to nine months)
- Rehabilitation to improve motion, being careful not to aggravate the symptoms by being too aggressive
- Anti-inflammatory medications may help
- Initially, shoulder may be resistant to treatment methods
- Fluoroscopically guided corticosteroid injection into the glenohumeral joint may aid in pain control and may allow rehabilitation to progress sooner
- Frozen Stage (approximately four to nine months after the freezing stage)
- Rehabilitation for mobilization and range of motion exercises
- Anti-inflammatory medications may help
- Thawing Stage (approximately five to 26 months following the frozen stage): Rehabilitation can be very beneficial during this stage in improving range of motion, strength, coordination and function
Treatment Option: Surgery
If conservative treatment fails, consisting of at least six to 12 months of consistent rehabilitation, then surgical treatment options may be considered.
- The surgery involves manipulation under anesthesia and shoulder arthroscopy. Following surgery, intense rehabilitation focuses on maintaining motion that is achieved under surgery.
- The manipulation under anesthesia portion of the surgery involves putting the patient to sleep and “manipulating” or forcing the shoulder to move causing the capsule to tear or stretch.
- The second part of the surgery is the shoulder arthroscopy. It involves several small incisions around the shoulder where instruments can be inserted into the shoulder joint to release the tight shoulder capsule.