Adhesive capsulitis is commonly known as “frozen shoulder”. Adhesive capsulitis develops as a gradual onset of decreased range of motion. Many people notice they have difficulty reaching overhead or behind their back.

Who’s at risk?

  • The most common risk factor is diabetes mellitus, especially type I. Adhesive capsulitis affects approximately 10% to 20% of all diabetics.
  • Frozen shoulder affects more women than men.
  • Usual onset begins between ages 30 and 65.
  • Other predisposing factors include:
  • A period of enforced immobility, resulting from trauma, overuse injuries or surgery
  • Hyperthyroidism
  • Cervical disk herniation
  • Cardiovascular disease
  • Clinical Depression
  • Parkinson’s disease
  • Breast or chest surgery

Causes of frozen shoulder

Most cases of adhesive capsulitis do not have a predisposing risk factor involved and are called idiopathic. The cause of this type of frozen shoulder is unknown, but probably involves an underlying inflammatory process. The capsule surrounding the shoulder joint thickens and contracts. This leaves less space for the upper arm bone (humerus) to move around. Frozen shoulder can also develop after prolonged immobilization because of trauma or surgery to the joint. Usually only one shoulder is affected, although in about 1/3 of cases, motion may be limited in both arms.

If a risk factor or predisposing factor is present and treatable, the underlying stiffness and pain in the shoulder will resolve with physiotherapy and treatment for the underlying condition.

 Stages of (idiopathic) development:

Frozen shoulder develops slowly, and in three stages.

  • Stage One: “Freezing”- Pain increases with movement and is often worse at night. There is a progressive loss of motion with increasing pain. This stage lasts approximately 2-9 months.
  • Stage Two: “Frozen”- Pain begins to diminish, and moving the arm is more comfortable. However, the range of motion is now much more limited, as much as 50 percent less than in the other arm. This stage may last 4-12 months.
  • Stage Three: “Thawing”- The condition begins to resolve. Most patients experience a gradual restoration of motion over the next 12-42 months; surgery may be required to restore motion for approximately 5% of patients.

Non-operative treatment includes:

  • Medications to reduce the inflammation and relieve the pain
  • A program of physiotherapy, often combined with home exercises and other therapies to actively stretch and help restore motion and function
  • Heating or icing the shoulder
  • Corticosteroid injections
  • Surgery is an option, but only if the pain has improved and the stiffness remains after 12-18 months.

Arthroscopic surgery can successfully release and repair the shoulder, but an exercise program to maintain motion and restore function must be initiated immediately after surgery.

Content adapted from the American Academy of Orthopaedic Surgeons. More information can be found at www.aaos.org

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