Adhesive Capsulitis or Frozen Shoulder: Epidemiology, Types, Signs, Symptoms, Causes, Risk Factors, Treatment

Adhesive capsulitis is also called as frozen shoulder syndrome. Adhesive capsulitis is a condition, which involves scarring, inflammation and tightening of the connective tissue around the joints of the shoulder, which results in shoulder pain and significant loss of range of motion of the shoulder.

The shoulder joint is a ball and socket type of joint. The socket of the shoulder is formed by the shoulder blade. The upper top part of the humerus or the upper arm bone forms the ball of the shoulder. A strong connective tissue surrounds the ball and socket joint holding the bones together. This forms the shoulder joint capsule.

The shoulder joint capsule may sometimes get inflamed leading to scarring and tightening of the shoulder joint capsule. This leads to marked loss of range of motion of the shoulder. This condition is known as adhesive capsulitis or frozen shoulder.

Adhesive capsulitis is most commonly seen in individuals who are over 40 years of age. The process of adhesive capsulitis generally occurs in three phases:

• In the first phase of adhesive capsulitis, the pain is experienced with movement of the shoulder. Stiffening of the shoulder may be experienced.
• In the second phase of adhesive capsulitis, the marked loss of motion is experienced along with scarring of the joint capsule. Difficulty while elevating the arm or taking the hand behind the back may also experienced.
• In the third and final phase of adhesive capsulitis, the shoulder starts loosening up with gradual restoration of normal function of the shoulder.

Adhesive capsulitis may affect people between 45 to 65 years of age. Adhesive capsulitis more commonly affects females when compared to males. Statistics show that 70 percent of females and 30 percent of males may get affected with adhesive capsulitis.

Adhesive capsulitis can be classified into two types :

• Primary Adhesive Capsulitis.
• Secondary Adhesive Capsulitis.

The particular cause of primary adhesive capsulitis is unknown. However, suspected causes may include hormonal and biochemical imbalances, few neurological and cardiovascular disorders, changes in the immune system and diabetes mellitus. Diabetes patients may be very much prone to develop the condition of adhesive capsulitis. Primary adhesive capsulitis generally affects both the shoulders, however, it is not necessary that both the shoulders may get affected at the same time. Also primary adhesive capsulitis is generally resistant to most of the treatments that can be offered to the patients.

Secondary adhesive capsulitis is often caused due to prolonged period of immobilization, stiffness following a shoulder injury, or a surgery. The condition of secondary adhesive capsulitis may become severe if left untreated and may also last from one to three years of duration. Some patients may also experience stiffness even after many years. However, this does not lead to any type of functional limitations or severe pain.

• Exacerbation of the pain during movements of the shoulder such as pushing, pulling, lifting, carrying, arm elevation, taking the hand behind the back and lying on the affected side.
• Deep pain in the shoulder with sometimes pain in the neck, upper arm, and upper back.
• Stiffness in the shoulder, neck, upper arm, and upper back.
• Pain often at night or on waking up in the morning.
• Reduction of pain as the condition progresses to the frozen phase.
• Marked stiffness and significant reduction of range of motion of the shoulder.
• Possible muscle wasting due to immobility.

The exact cause of adhesive capsulitis is unknown. However few of the suspected reasons are mentioned below.

• Damage or injury to the shoulder joint or surrounding soft tissue.
• Excessive shoulder use without adequate rest.
• Prolonged period of immobility.
• Poor posture.
• Cervical disc disease.
• Shoulder surgery.
• Diabetes.
• Hyperthyroidism.
• Auto-immune diseases.

In most of the cases adhesive capsulitis resolves on its own over a period of a year to year-and-a-half. Treatment for adhesive capsulitis basically focuses on alleviating pain and trying to preserve as much range of motion as possible in the affected shoulder.

Treatment primarily starts with medications. Medicines may involve over-the-counter pain relievers like ibuprofen and aspirin, which help in reducing inflammation and pain associated with adhesive capsulitis. In some cases, stronger anti-inflammatory drugs and pain-relievers are also prescribed.

Corticosteroid injections may be used to help in improving shoulder mobility and decreasing the pain.

Shoulder manipulation is done in some cases. This involves moving the affected shoulder in various directions under general anesthesia. This helps in breaking down the scar tissues and adhesions and loosening up the tightened tissues in the shoulder joint.

Surgery is performed in very severe cases, which involves removing the scar tissue and adhesions formed in the joint of the shoulder. This is usually done with arthroscopic technique, which involves small incisions and has a shorter recovery period compared to the traditional surgery.

Physical therapy is required for all the patients to speed up the healing process and restore normal functioning of the shoulder. Physical therapy may include :

• Joint mobilization.
• Soft tissue massage.
• Dry needling.
• Electrotherapy or ultrasound.
• Taping or bracing.
• Application of ice or heat.
• Exercises to improve strength and flexibility.
• Activity modification and training.
• Appropriate plan for return to activity.
• Hydrotherapy.
• Postural correction.

Generally a complete subjective and physical examination is performed to diagnose adhesive capsulitis. Other tests may include:

• MRI.
• Ultrasound.

Also Read:

• Massage For Frozen Shoulder
• Ayurvedic Treatment for Frozen Shoulder
• First Signs of Frozen Shoulder & its Treatment
• Frozen Shoulder Exercises