Causes of Frozen Shoulder/Adhesive Capsulitis
Frozen shoulder, also known as adhesive capsulitis, can include dull, achy pain as well as progressively worse immobilization of the shoulder. There is no clear cause of frozen shoulder, but it is most common in people aged 40 – 60. People with diabetes are at an increased risk for frozen shoulder, as are those who have had their shoulder immobilized in order to heal from an injury or surgery. Frozen Shoulder occurs when the shoulder capsule, the area surrounding the shoulder joint and rotator cuff tendons, becomes stiff and tight. Thick bands of tissue develop, and there is a reduction of synovial fluid (lubricant) in the joint. There are typically three stages of frozen shoulder: For 6 weeks to 9 months, pain will worsen and range of motion will decrease. For 4 – 6 months, the pain may subside but stiffness will remain. Then, the shoulder will slowly “thaw” over a period of 6 months to 2 years.
Diagnosing and Treating Frozen Shoulder Without Surgery
Diagnosis begins with a physical examination to determine range of motion and activities that cause pain. We may use an X ray or MRI to rule out other causes for the pain, such as arthritis or torn tissues. When diagnosis is confirmed, treatment begins with NSAIDs and physical therapy to help restore motion. In more severe cases, steroid injections may help reduce inflammation.
Surgery for Frozen Shoulder/Adhesive Capsulitis
If physical therapy and conservative treatment fail to relieve painful symptoms, manipulation under anesthesia (MUA) or arthroscopic surgery may be considered. During MUA, the patient is put to sleep while the doctor moves the shoulder to stretch and tear scar tissue, releasing tightness and increasing range of motion. In shoulder arthroscopy, the doctor will cut through tight portions of the joint capsule. Often, the two treatments are used together to obtain maximum results. Recovery times vary from 6 weeks to 3 months, and physical therapy is a key to maintain range of motion achieved from surgery. Patients typically experience reduced pain and improved range of motion, but in some cases some stiffness and lost range of motion remain for many years.