Anatomy & Background

Adhesive capsulitis, more commonly known as frozen shoulder, is an inflammatory condition of the shoulder accompanied by pain, loss of function and decreased shoulder mobility known as the characteristic “frozen” feeling. It typically presents most often in females aged 40 to 60 years old.

What happens when your shoulder “freezes?”

The joint capsule is a sleeve of connective tissue that supports and provides stability to the shoulder joint. When inflamed, the capsule constricts, causing painful tightness and limiting your range of motion. As the capsule shortens and range of motion decreases, other muscles connected to the area can shorten as well and atrophy compounding movement restrictions.

Causes

Adhesive capsulitis is often triggered by other inflammatory conditions such as bursitis, tendonitis or shoulder impingement. Other activities or conditions that put an individual at risk to the development of adhesive capsulitis includes:

  • Participating in repetitive overhead athletic activities like swimming, tennis, softball, or baseball.
  • Repetitive strain, stemming from overuse on the job.
  • Sudden trauma to the shoulder.
  • Very infrequently, frozen shoulder may develop during post surgical shoulder rehabilitation (including open and arthroscopic procedures and shoulder joint replacements) if the patient does not adhere to the rehabilitation schedule.
  • Patients with a history of diabetes or uncontrolled blood sugar levels may develop a special type of frozen shoulder called “Diabetic Shoulder”.

Signs and Symptoms of Frozen Shoulder

  • Shoulder pain and muscle weakness that radiate to the upper arm.
  • Moderate to severe loss of shoulder motion, especially the ability to reach overhead and behind the back.
  • Difficulty dressing and performing activities of daily living (ADL’s).
  • Pain when sleeping followed by discomfort and tightness upon waking.

Medicine Intervenes

A health care professional may recommend the following listed below in addition to physical therapy.

  • The use of NSAIDs (Non-Steroidal Anti-Inflammatory Drugs).
  • Steroidal injections to reduce inflammation.
  • A pain management program, including medication, designed to reduce discomfort so the patient may be able perform recommended exercises.
  • Manipulation or passive movement of the restricted shoulder joint under anesthesia to improve motion, break up scar tissue, adhesions and restore function. Use of this treatment is rare, but occasionally is necessary, depending on the severity of the condition.
  • Surgery to correct underlying pathology or the cause of the frozen shoulder.

Prognosis

Under a comprehensive physical therapy rehabilitation program, many individuals are able to limit the effects of connective tissue dysfunction and will likely see a decrease in symptoms over a period of time ranging between two weeks and six months. For patients with more advanced cases or if results are not realized after a significant time period, surgical intervention may be considered.