Adhesive Capsulitis

As noted above, the primary symptoms of adhesive capsulitis is pain.  The shoulder hurts, and motion may become painful for many otherwise ordinary activities.  Lifting the arm overhead, reaching across the body, reaching a bra or behind the back become increasingly difficult or impossible.

The evaluation of a frozen shoulder typically starts with radiographs, which are characteristically normal.  Although these films are normal in this disease, they are an important part of the evaluation because it helps to exclude other problems in the shoulder joint, such as osteoarthritis, calcific tendonitis, and deformities of the shoulder bones.  The problem is in the soft tissue, and although MRI is helpful to screen for conditions that may also be present, the MRI is not always needed.

Frozen shoulder is diagnosed by a careful physical examination where the motion of the shoulder is noted to be limited.  There is a limitation of not only active motion (which is the range of motion the patient can produce on their own will) but also passive motion (where the examiner cannot move the joint any further than the patient can). The limits of motion are very painful and just stretching the shoulder for the examination can be uncomfortable.  Although this can cause pain, a thorough physical examination is critical because without the examination, the condition can be missed.

The initial treatment for frozen shoulder depends on several factors which may be unique to the patient and individualized for the individual circumstances of the case.  Severe cases with substantial motion loss can benefit in the early stages (or first visit) with a cortisone injection, which is a powerful anti-inflammatory and cuts down the irritation and pain.  This is only temporary, however, and the benefit of the cortisone is best achieved with a vigorous course of exercises called “terminal stretches” where the shoulder is pushed to the limits of tolerable motion and held there, so as to stretch the capsule tissue of the shoulder.  This stretching program can be very painful, and the cortisone helps to limit the discomfort, coupled with heat and ice used strategically.  Also helpful is an evaluation and treatment by a physical therapist, who is trained to guide the patient through exercises that specifically target the inflamed capsule tissue in the shoulder and to teach the patient home exercises while the patient stretches the shoulder on his or her own.

Cases of frozen shoulder that are persistently painful, not responsive to initial stretching treatment, or are an ongoing cause of functional impairment may be amenable to an arthroscopic procedure called a release, where the abnormal tissue in the shoulder is released in a minimally invasive fashion (with the “scope”), which frees the tissue so the shoulder immediately regains the range of motion.  Following this procedure, the patient is instructed to work diligently with a physical therapist to continue stretches to continue to maintain the motion achieved during the procedure.  While there are other procedures described for frozen shoulder such as a manipulation under anesthesia (MUA) where the patient is put to sleep and the shoulder forcefully manipulated to restore motion, this procedure has a higher rate of complications including tendon or other soft tissue injury and bone fracture and therefore has largely been replaced with more specific and modern arthroscopic techniques.