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Adhesive Capulitis – When More Than Just the Weather is Frozen

January 1, 2015

What is Frozen Shoulder?

Frozen shoulder, or adhesive capsulitis, refers to a painful and often debilitating shoulder condition characterized by a gradual onset of pain with severe limitations in range of motion of the affected shoulder. In people with frozen shoulder, the joint capsule (the connective tissue surrounding the bones, ligaments and tendons of the shoulder joint) becomes thicker and tighter, restricting the motion of the entire shoulder complex. This makes it more difficult to move your shoulder actively, and can impair your ability to perform basic daily tasks, such as fastening a bra, tucking in your shirt, or reaching overhead.

frozen-shoulder

Who Gets a Frozen Shoulder?

While frozen shoulder can develop after minor injuries or after prolonged immobilization, it often develops spontaneously (also known as idiopathic adhesive capsulitis). Although the causes of frozen shoulder are not well understood, there are some populations who are more at risk than others. Frozen shoulder affects between 2% and 5% of the general population, but approximately 70% of those who develop this condition are female. The typical age range for a person with frozen shoulder is 40-60 years old, and it is more prevalent in the person’s non-dominant arm. Other co-morbidities can have a significant effect on a person’s risk of developing frozen shoulder. Nearly 20% of those with diabetes will develop frozen shoulder. Thyroid disease and cardiovascular disease are also significant risk factors for frozen shoulder.

Stages of Frozen Shoulder

Stage 1 – Pre freezing

This is when your symptoms have been around for 1-3 months, and you are having pain with active and passive movements. You may have some limitations in your range of motion, but the shoulder is typically more painful than stiff at this time.

Stage 2 – Freezing

In this stage, your symptoms have most likely been around for 3-9 months, and you are losing more range of motion. The pain in your shoulder has increased, and is becoming more chronic. This video shows some of the typical loss of range that can occur with a shoulder in the freezing stage:


Stage 3 – Frozen

The symptoms have been around 9-14 months, and the pain is decreasing overall. The range of motion in your shoulder is significantly limited in all directions.

Stage 4 – Thawing

This stage occurs between 12-24 months after the onset of the frozen shoulder, and there are improvements in the pain levels and the range of motion. It should become easier to perform functional tasks.

How Frozen Shoulder is Treated

Although suffering from a frozen shoulder can be a long and painful road, the good news is that 90% of people with frozen shoulder respond well to conservative treatment and do not require surgery. Physical therapy is a key component of conservative treatment for frozen shoulder, and may incorporate a number of different treatments. Your therapist will assess your range of motion and functional limitations to help determine which stage of the condition you are in, and will design a treatment plan specifically for you. These treatments may include manual therapy, joint mobilization and stretching to help improve the mobility of the joint capsule and regain your range of motion. Heat or ice, and electrical stimulation may be used to help break the pain cycle in your shoulder, and improve your tolerance for daily activities. A home exercise program to gradually increase your mobility and help regain your strength will also be a key component of successful treatment. These techniques all work together to help restore the normal mechanics of your shoulder joint and return you to your favorite activities pain-free.

References

  1. Buchbinder R, Youd J, Green S, et al. Efficacy and Cost-Effectiveness of Physiotherapy Following Glenohumeral Joint Distension for Adhesive Capsulitis:  A Randomized Trial. Arthritis and Rheumatism 2007; 57(6): 1027-1037.
  2. Griggs S, Ahn A, Green A. Idiopathic  Adhesive Capsulitis: A Prospective Functional Outcome Study of Nonoperative Treatment. JBJS 2000; 82-A(10): 1398-1407.
  3. Jewell D, Riddle D, Thacker L. Interventions associated with an increased or decreased likelihood of pain reduction and improved function in patients with adhesive capsulitis: a retrospective cohort study. Phys Ther. 2009; 89: 419-429.
  4. Kelley M, Shaffer M, Kuhn J, Michener L, Seitz A, Uhl T, Godges J, McClure P. Shoulder Pain and Mobility Deficits: Adhesive Capsulitis. J Orthop Sports Phys Ther 2013; 43(5): A1-A31.
  5. Neviaser A, Hannafin J. Adhesive capsulitis: a review of current treatment. Am J Sports Med 2010; 38: 2346–2356.