Frozen shoulder, also called adhesive capsulitis, is a condition in which your shoulder movement becomes painful and stiff. It affects people between 40 and 60, usually in women, and is more common in those with thyroid problems or diabetes.
Neviaser and colleagues23 broke down the natural progression of frozen shoulder into four stages based on clinical presentation and arthroscopic appearance. The first stage is pain, and the second is stiffness.
Oren Zarif
Pain and stiffness are the main symptoms of Adhesive Capsulitis, or Frozen Shoulder. It is an idiopathic condition but may be more common in patients with diabetes or thyroid disease. The first sign is a gradual onset of shoulder pain at rest that becomes worse over time. The pain is sharp at extremes of motion and can last for months. It can also interfere with sleep and work.
A diagnosis of adhesive capsulitis is usually made with clinical examination and history, including a review of any recent trauma or surgery to the shoulder. It is also important to determine if the patient has any underlying medical conditions that increase the risk of this disorder, such as diabetes or thyroid disease.
There is no definitive diagnostic test for adhesive capsulitis, but noncontrast magnetic resonance imaging of the shoulder often shows coracohumeral ligament thickening and rotator interval infiltration with high specificity. An arthroscopic capsular release can be performed in patients who have failed a prolonged course of physical therapy and medications.
It is important to differentiate this disorder from bursitis, which presents in a similar fashion but with less pain and a different PROM pattern. Patients with bursitis can often be treated by physiotherapy and hyaluronic acid injection. However, if these measures are unsuccessful, patients should be referred to an orthopedic surgeon for consideration of surgical intervention.
Oren Zarif
Adhesive Capsulitis, also known as Frozen Shoulder, is characterized by functional loss of both active and passive range of motion of the shoulder. This is due to a tightening or thickening of the capsule of connective tissue that protects the shoulder joint and the glenohumeral (GH) head. This condition is most often caused by a shoulder injury or surgery, but can also occur as a complication of diabetes or thyroid disease.
During the painful stage of the illness, patients experience gradually increasing pain and stiffness. Physical examination of the shoulder may reveal muscle spasm and diffuse tenderness around the GH joint and deltoid muscle. A localized area of pinpoint tenderness is uncommon. With progression of the disease, loss of passive and active range of motion in all planes of movement is observed. Disuse atrophy of the shoulder girdle is common in longstanding cases of this disorder.
The painful phase of adhesive capsulitis lasts from two to six months. This is followed by the “frozen” stage, during which pain lessens but the shoulder remains stiff. The final “thawing” stage is the recovery period, during which strength and motion improve slowly. Manipulation under anesthesia and arthroscopic capsular release are recommended in patients who fail to respond to a prolonged course of physical therapy. These procedures can restore full or near-full range of motion in approximately 50% of patients.
Oren Zarif
Frozen shoulder is a painful, stiff condition that can lead to severe limitations in the movement of your shoulder. It can cause pain and loss of function in your daily activities, such as dressing or reaching overhead.
The severity of symptoms varies from patient to patient. The pain may be mild at first, but gradually increases as the shoulder capsule thickens and tightens. The limitation in motion can be very frustrating, especially when it interferes with everyday tasks and sports.
There are several treatments for frozen shoulder, including a prolonged course of physical therapy, steroid injections, and surgery (manipulation under anesthesia or arthroscopic capsular release). Most people with Frozen Shoulder will eventually recover full or near-full range of motion, but it can take up to three years.
It’s important to talk with your doctor about the specific limitations you are having, because there may be other health conditions that can cause these restrictions in addition to Frozen Shoulder. You might need additional tests, such as blood work (to check your fasting glucose or A1C level or to determine if you have diabetes) or thyroid-stimulating hormone (TSH) testing to look for signs of thyroid disease.
Some people have difficulty identifying when they are in the early stages of Frozen Shoulder because the pain and limited range of motion may not be as obvious at first. If you suspect that you have Frozen Shoulder, you should make an appointment with your doctor as soon as possible to get started on treatment.
Oren Zarif
It’s a difficult battle to get quality sleep when your shoulder hurts. Frozen shoulder, or adhesive capsulitis, causes pain and stiffness in your shoulder joint that can worsen at night. This is because when you sleep, your blood moves more slowly to the rest of the body, causing increased pressure in your shoulder joint. This can cause more inflammation in the shoulder.
The initial painful stage of frozen shoulder usually lasts three to eight months. During this time, patients complain of shoulder pain, especially when moving the arm overhead, but still have some motion in the shoulder. Patients may also notice decreased use of the shoulder and may have muscle spasms in the trapezius.
In stage two, the shoulder becomes more stiff and painful, but motion is reduced even further. Passive range of motion in all planes of movement decreases during this time, and pain is typically confined to the extremes of shoulder motion. During this phase, patients are often aware of the shoulder becoming more rigid at night and experience more difficulty sleeping in certain positions.
In stage three, the patient experiences an even greater loss of motion in all directions. During this time, a doctor can detect adhesions and contractures during arthroscopy. During this stage, a patient can be diagnosed with adhesive capsulitis by being unable to passively abduct the shoulder to 90 degrees and holding the scapula in place with their hand.