Frozen Shoulder or “Adhesive Capsulitis”

Frozen shoulder (adhesive capsulitis) is a common condition that begins with inflammation of the lining of the shoulder glenohumeral (ball and socket) joint, i.e.- the capsule.  Causes include injury or overuse, but sometimes the etiology is unclear or unknown.

Symptoms include pain and stiffness, with variable loss of range of motion of the shoulder.  A person with adhesive capsulitis may not appreciate the loss of motion, as they may not want to move the arm because of pain.  The condition may begin suddenly or gradually.  Osteoarthritis of the shoulder may present with similar symptoms, but an X-ray can distinguish between the two. 

The natural history of the frozen shoulder is a slow, gradual recovery that often takes many months. There may be a relationship with diabetes and other conditions, and in a diabetic or someone with a thyroid abnormality, recovery can be prolonged or even incomplete. Recommended conservative treatment measures include physical therapy 2-3 days a week for ROM and stretching. Other measures such as home exercises, swimming, anti-inflammatory medication, etc., are typically effective and useful. A long term course is to be expected with gradual improvement over time.

Steroid injections may be helpful if the above measures are unsuccessful.  Surgical manipulation or arthroscopic capsular release is reserved for persistent cases that resist conservative care.  Risks including fracture, dislocation and nerve injury with possible permanence must be considered. More than 95% of people with adhesive capsulitis get better with consistent, ongoing physical therapy and other conservative measures. Studies such as MRI may be necessary if there is failure to progress. The patient should follow up at regular intervals to monitor response to conservative intervention, and follow improvement.

A common problem these days is convincing insurance companies to continue to pay for the ongoing need for rehabilitation, as recovery may be prolonged.