Adhesive Capsulitis: Stages, Causes & Management
The human shoulder is a complex joint that is normally capable of moving in many planes. Adhesive capsulitis (commonly called “frozen shoulder“) is the term used to describe a generalized reduction in the shoulder range of motion.
The joint usually doesn’t completely “freeze,” but maintains some degree of mobility. Though most sufferers recover spontaneously, treatment—rather than simple observation—leads to a better outcome.
Causes of Frozen Shoulder
Trauma
Injury or chronic overuse leads to joint inflammation and the formation of granulation tissue, with the subsequent development of capsular thickening and fibrous adhesions.
Endocrine and Metabolic Disease
Diabetics have a higher incidence of frozen shoulders, probably because poor circulation leads to abnormal collagen repair and degenerative changes. Likewise, individuals with thyroid, cardiac, or lung disease are more prone to adhesive capsulitis.
Autoimmune Illness
Serum markers for inflammation are occasionally elevated with adhesive capsulitis. These markers may normalize when the shoulder condition resolves, indicating a possible autoimmune component. Furthermore, patients with concurrent autoimmune illnesses, such as rheumatoid arthritis, frequently develop frozen shoulders.
Disuse Syndromes
Post-mastectomy patients, stroke victims, and other individuals whose upper limb motion is restricted have a higher incidence of adhesive capsulitis.
Idiopathic
No specific underlying cause can be identified. 30 years ago, Grey defined this condition as one of “unknown etiology, characterized by gradually progressive, painful restriction of all joint motion… with the spontaneous restoration of partial or complete motion over months to years.” (J Bone Joint Surg [Am] 1978:60:564.)
Stages of Adhesive Capsulitis
Frozen shoulder typically evolves in three distinct stages:
Painful stage (lasts three to eight months)
Generalized pain in the shoulder—often associated with muscle spasms—increases with motion. Pain frequently increases at night.
Adhesive stage (lasts four to six months)
Pain begins to decrease, but stiffness and limitation of motion worsen. Nocturnal pain, if present, lessens. The greatest discomfort is experienced at extreme ranges of movement.
Recovery stage (lasts one to three months)
The pain subsides; a range of motion, which is severely restricted early in this stage, gradually returns. Recovery may be incomplete, particularly for untreated patients.
Treatment for Frozen Shoulder
Non-steroidal anti-inflammatory medications (ibuprofen, naproxen, COX-2 inhibitors), narcotic analgesics, intra-articular corticosteroid injections, and even surgery are components of a therapeutic approach to adhesive capsulitis.
Arguably, the most important aspect of treatment is maintaining shoulder motion. Physical therapy is prescribed for most patients. A series of simple exercises that can be performed twice daily at home include:
Climbing the Wall
The patient faces a wall and places the hand flat against the wall. Using the fingers to crawl, spider-like, upward, the goal is to reach as high as possible, pausing every few inches to hold the position for 30 seconds. The same maneuver is then performed with the arm extended to the side. At each session, an effort is made to reach a little higher.
Codman Exercises
Sitting sidewise on a chair, the affected arm is draped over the chair’s back, with the chair back in the armpit. The dangling arm is swung in increasingly large circles for 30 seconds, and then the circles are repeated in the opposite direction. This same exercise can be performed while leaning forward over a low counter and letting the affected arm hang straight downward.
Rotation
Alternatively reaching for the back of the head (as if combing the hair) and then reaching behind the back (as if reaching for a zipper or shirttail) takes the shoulder through internal and external rotation.
Once adhesive capsulitis or frozen shoulder has resolved, it is important to continue range-of-motion exercises on a daily basis.
External links
- American Academy of Orthopedic Surgeons, “Frozen Shoulder”
- Ultrasound of the Shoulder: “Adhesive Capsulitis”
- “Adhesive capsulitis: a sticky issue”, Siegel, Lori B.; Cohen, Norman J.; Gall, Eric P.
- Russian Journal of Manual Therapy, Dec 2012. | A “Neuromanual” treatment for frozen shoulder using local anesthetic
