Educational Handout

Educational Handout for Adhesive Capsulitis or Frozen Shoulder.

Frozen shoulder is a common, painful condition that frequently affects people over 50 years of age. A more correct medical term to describe frozen shoulder would be adhesive capsulitis. Besides pain shoulder, shoulder movement is limited in more than three planes. The connective tissue surrounding the glenohumeral joint of the shoulder becomes inflamed and stiff, greatly restricting motion and causing chronic pain.

Movement of the shoulder is severely restricted. Pain is usually constant is even worse at night. Cold weather and temperature would cause more pain in the shoulders. Certain movements or bumps can cause sudden onset of tremendous pain and cramping that can last several minutes. The exact cause of adhesive capsulitis is unknown. It can last from five months up to three years or more and is thought in some cases to be caused by injury or trauma to the area. Some scholars believe that it may have an autoimmune component, with self auto-antibodies attacking the healthy tissues in the shoulder capsule. The shoulder joint also lacks joint fluid, further restricting shoulder movements. Patients with adhesive capsulitis usually may experience problems with sleeping for extended periods due to pain that is worse at night. Therefore, this condition also can lead to depression, pain, and problems in the neck and back. Risk factors for frozen shoulder include diabetes, stroke, accidents, lung disease, connective tissue disorders, thyroid disease and heart disease. The condition very rarely appears in people under 40.

One sign of a frozen shoulder is that the joint becomes so tight and stiff that it is nearly impossible to carry out simple movements, such as raising the arm. The movement that is most severely inhibited is external rotation of the shoulder. The normal course of a frozen shoulder has been described as having three stages:

• Stage one: The "freezing" stage that may last from six weeks to nine months, and in which the patient has a slow onset of pain. As pain aggravates, the shoulder loses motion.
• Stage two: The "frozen" or adhesive stage is marked by a slow improvement in pain but shoulder stiffness remains. This stage usually lasts from four to nine months.
• Stage three: The recovery stage where shoulder motion slowly returns to normal. This generally lasts from 5 to 26 months.

Treatments of adhesive capsulitis may be painful and consists of physical therapy, medication, massage therapy, hydrodilatation or surgery. Manipulation under anesthesia is a treatment option that breaks up the adhesions and scar tissue in the joint to help restore some range of motion. Pain and inflammation can be controlled with analgesics and NSAIDs. Adhesive capsulitis can be self-limiting. It can resolve over time without surgery and other aggressive treatments, but this may take up to two years. Most people regain about 90% of shoulder motion over time.