Anatomy/Pathophysiology – Adhesive Capsulitis Frozen Shoulder
Adhesive capsulitis, or “frozen shoulder”, is a painful condition which results in a severe loss of motion in the shoulder. It may follow an injury to the shoulder, but may also arise gradually with no warning or injury. The shoulder actually “freezes up” due to a severe inflammation of the joint capsule. The slack tissue that usually allows a great deal of motion at the shoulder sticks together, limiting the motion. The cause of this condition is largely a mystery. One theory suggests that the condition may arise from an “autoimmune” reaction. During an autoimmune reaction the body mistakenly begins to attack portions of itself, thinking that the tissue under attack is “foreign”. This causes an intense inflammatory reaction to the tissue that is under attack.
Symptoms – Adhesive Capsulitis Frozen Shoulder
The symptoms are primarily pain and a very reduced range of motion in the joint. The range of motion is the same whether your are trying to move the shoulder under your own power or if someone else is trying to raise the arm for you. There comes a point in each direction of movement where the motion simply stops as if there is something blocking the movement. The shoulder usually hurts when movement reaches the limit of the range of motion, and can be quite painful at night.
Diagnosis – Adhesive Capsulitis Frozen Shoulder
The diagnosis of frozen shoulder is usually made on the history and physical examination. Shoulder motion is the same, whether the patient or the doctor tries to move the arm. Xrays are usually not helpful, although an arthrogram may confirm that the shoulder capsule is scarred and contracted. As the motion increases in the shoulder, your doctor may suggest tests that look for an underlying condition, such as impingement, or a rotator cuff tear, that may have initiated the condition.
Treatment – Adhesive Capsulitis Frozen Shoulder
Treatment of the frozen shoulder can be frustrating and slow. Most cases will eventually improve, but it may be a process that takes months. Initial treatment is directed at decreasing inflammation and increasing the range of motion of the shoulder with a stretching program. Anti-inflammatory medications may be prescribed. It is critical that a Physical Therapy program be started and continued to regain the loss of motion.
An injection of cortisone and long-acting anesthetic may bring the inflammation under better control, and allow the stretching program to be more effective. In some cases, injecting a long acting anesthetic along with the cortisone right before a stretching session with the Physical Therapist can allow the therapist to break up the adhesions while the shoulder is numb from the anesthetic.
If progress is slow, your doctor may recommend a manipulation of the shoulder while you are under anesthesia. This procedure allows your doctor to stretch the shoulder, and break up the scar tissue while you are asleep. In most cases, a manipulation of the shoulder will increase the motion in the shoulder joint faster than allowing nature to take its course. It may be necessary to repeat this procedure several times. Perhaps after surgery a visit to a physical therapist will be ordered from your doctor.