Understanding Adhesive Capsulitis – AKA “Frozen Shoulder”
By: Brian Lee, MD
Frozen shoulder is a condition that occurs when inflammation in the capsule where the shoulder resides leads to a “sticking” of the head of the humerus or upper arm bone inside that socket. This condition more frequently impacts people between 40-65 years old and occurs more often in women than in men. Interestingly, though the hip is also a “ball and socket joint” like the shoulder, adhesive capsulitis is not a condition that affects the hip or any other major joint in the body such as the knee or elbow – it only occurs in the shoulder.
Adhesive capsulitis is still considered “idiopathic” by the medical community. Idiopathic means that the condition’s origin or exact cause is unknown. What is known about a frozen shoulder is that inflammation is a critical factor in setting off what appears to be a cascade of chemicals in the body that specifically irritate the shoulder joint. Sometimes a frozen shoulder can arise due to an injury, but often this is a condition that seems to “come out of nowhere” for many patients.
Patients often wake up one day with intense pain in one Shoulder that tends to feel progressively stiffer over time, resulting in a significantly reduced range of motion in the upper arm.
Adhesive capsulitis tends to present itself in three phases or stages. In the early stage, there is pain in the shoulder which gradually worsens, but the arm’s range of motion is usually retained. In other words, the shoulder hurts, but it is still functional. During stage two, the range of motion in the shoulder becomes impacted, and inflammation in the shoulder joint worsens. Stage three is often called the “thawing” phase, where the pain and range of motion gradually improve. Of course, the question on most patients’ minds who suffer a frozen shoulder is – how long will it take to get better? Unfortunately, the answer isn’t that easy and depends significantly on each case – some frozen shoulders take months to resolve, others can take years.
The first frozen shoulder experience tends to occur in the non-dominant arm. Unfortunately, the risk of experiencing adhesive capsulitis in the other shoulder increases after the first episode.
A doctor’s diagnosis of adhesive capsulitis involves a complete history and physical examination that involves testing the active and passive motion of the affected shoulder. Sometimes the doctor will also take an x-ray of the shoulder to rule out other conditions like arthritis. Once a diagnosis is made, treatment can involve a variety of approaches primarily aimed at reducing pain, decreasing inflammation, and restoring range of motion in the shoulder. Treatments may include anti-inflammatory medications, either taken orally or by injection, and physical therapy. At-home exercises may also be recommended so that the patient continues to work on improving the shoulder’s range of motion while it heals. Especially in cases where recovery takes a year or longer, treatments like these are essential to help reduce the risk of permanent range-of-motion loss. In severe cases and when conservative treatments fail to provide relief, a surgical procedure called the doctor may recommend arthroscopic capsular release. During this procedure, the surgeon will release the joint capsule that has stiffened while also removing any built-up scar tissue.
Some factors beyond age and gender can increase a person’s risk of developing adhesive capsulitis. Genetics appear to be a factor in the experience of frozen shoulder, with a higher risk placed on people with a first-degree relative who experienced the condition. Studies suggest that people with Type 2 diabetes may be up to five times more prone to developing adhesive capsulitis than people who do not have diabetes. In addition, people who have thyroid disorders appear to be at an increased risk and those who recently underwent breast cancer or heart surgery.
While the exact cause of adhesive capsulitis remains a mystery for the medical community to solve – treatments are available and more importantly, effective. Be sure to talk to your doctor, or preferably an orthopedic specialist, who can help you embark on the best and most healing treatment path for you. No person should “just live with” the pain or disability from a frozen shoulder.