Frozen shoulder (adhesive capsulitis)
Frozen shoulder, also known as adhesive capsulitis, is a disorder characterized by pain, stiffness, and loss of range of motion in the shoulder. It affects about two percent of the general population, and it is most common in women who are over 40 years of age.
The causes of frozen shoulder are not fully understood. The process involves thickening and contracture of the shoulder joint capsule. The process does not occur in any other joint in the body. For reasons unkown, the nondominant shoulder is affected more often than the dominant one. Frozen shoulder is not normally associated with calcium deposits, rotator cuff injuries, arthritis or malignancies. The x-rays of the shoulder are completely normal.
Medical problems associated with increased risk of frozen shoulder include diabetes, thyroid disease, Parkinson's disease, and cardiac disease. Frozen shoulder affects about 10 to 20 percent of people with diabetes, therefore a work-up for diabetes or other disorders may be recommended if a frozen shoulder occurs.
Another risk facter for development of frozen shoulder is prolonged immobilization. After an injury to the shoulder, early motion is usually recommended (assuming that the shoulder is stable) in hopes of avoiding the development of a frozen shoulder.
This condition is diagnosed by a doctor based on the history of the patient's symptoms and physical examination. X-rays or MRI (magnetic resonance imaging) studies are sometimes used to rule out other causes of shoulder stiffness and pain, such as rotator cuff tear.
The hallmark of frozen shoulder is pain with restricted motion of the shoulder. The pain is usually dull or aching. It usually becomes worse with motion, and it limits the patient's use of the affected shoulder and arm. Motion is also limited when someone else attempts to move the shoulder for the patient, as when a doctor performs a physical exam. Some physicians have described the normal course of a frozen shoulder as having three stages. Each stage has been reported to last roughly 4 months, but the time frame for each patient can be highly variable.
The vast majority of individuals will get better if given sufficient time, so surgery is not often required. Surgical intervention is considered only after an appropriate course of physical therapy and anti-inflammatory medications has failed.
Surgical intervention is aimed at stretching or releasing the contracted joint capsule of the shoulder. This usually consists of manipulation under anesthesia and/or shoulder arthroscopy:
Often, manipulation and arthroscopy are used in combination to obtain a full range of motion for the shoulder joint. Most patients have very good results with these procedures. It is critically important to begin physical therapy immediately after surgery to maintain the motion that was achieved intraoperatively.