Frozen Shoulder (Adhesive Capsulitis)

  • Medical Author:
    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

  • Medical Editor: Catherine Burt Driver, MD
    Catherine Burt Driver, MD

    Catherine Burt Driver, MD

    Catherine Burt Driver, MD, is board certified in internal medicine and rheumatology by the American Board of Internal Medicine. Dr. Driver is a member of the American College of Rheumatology. She currently is in active practice in the field of rheumatology in Mission Viejo, Calif., where she is a partner in Mission Internal Medical Group.

Frozen shoulder (adhesive capsulitis) facts

  • Frozen shoulder is the result of scarring, thickening, and shrinkage of the joint capsule.
  • Any injury to the shoulder can lead to adhesive capsulitis.
  • Frozen shoulder symptoms and signs include loss of range of shoulder movement, stiffness, and pain.
  • A frozen shoulder is usually diagnosed during an examination.
  • A frozen shoulder usually requires aggressive treatment.

What is a frozen shoulder?

A frozen shoulder is a shoulder joint with significant loss of its range of motion in all directions. The range of motion is limited not only when the patient attempts motion but also when the doctor attempts to move the joint fully while the patient relaxes. A frozen shoulder is medically referred to as adhesive capsulitis.

What causes a frozen shoulder?

Frozen shoulder is the result of inflammation, scarring, thickening, and shrinkage of the capsule that surrounds the normal shoulder joint. Any shoulder injury can lead to a frozen shoulder, including tendinitis, bursitis, and rotator cuff injury (rotator cuff syndrome). Adhesive capsulitis occurs more frequently in patients with risk factors of diabetes, chronic inflammatory arthritis of the shoulder, or after chest or breast surgery. Long-term immobility of the shoulder joint can put people at risk to develop a frozen shoulder.

What are symptoms and signs of a frozen shoulder?

Symptoms and signs of a frozen shoulder include shoulder pain, stiffness, and loss of range of shoulder motion. The shoulder range of motion is limited when either the patient or an examiner attempts to move the joint. The shoulder can develop increased pain with use. These symptoms can make sleep very uncomfortable.

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Shoulder pain symptoms and signs

Shoulder pain can be a result of injury or disease of the shoulder joint. Injury can affect any of the ligaments, bursae, or tendons surrounding the shoulder joint. Injury can also affect the ligaments, cartilage, menisci (plural for meniscus), and bones of the joint.

Common injuries of the shoulder can lead to inflammation of the bursae (bursitis) or tendons (tendonitis) and result in rotator cuff dysfunction as well as instability and frozen shoulder.

How do health care professionals diagnose a frozen shoulder?

A frozen shoulder is suggested during examination when the shoulder range of motion is significantly limited, with either the patient or the examiner attempting the movement. Underlying diseases involving the shoulder can be diagnosed with the history, examination, blood testing, and X-ray examination of the shoulder.

If necessary, the diagnosis can be confirmed when an X-ray contrast dye is injected into the shoulder joint to demonstrate the characteristic shrunken shoulder capsule of a frozen shoulder. This X-ray test is called arthrography. The tissues of the shoulder can also be evaluated with an MRI scan.

What conditions can mimic adhesive capsulitis?

Inflammation of the shoulder joint (arthritis) or the muscles around the shoulder and degenerative arthritis of the shoulder joint can cause swelling, pain, or stiffness of the joint that can mimic the range of motion limitation of a frozen shoulder.

Injury to individual tendons around the shoulder (tendons of the rotator cuff) can limit shoulder-joint range of motion but usually not in all directions. Often during the examination of a shoulder with tendon injury (tendinitis or tendon tear), the doctor is able to move the joint with the patient relaxed beyond the range that the patient can on their own.

What is the treatment for a frozen shoulder?

The treatment of a frozen shoulder usually requires an aggressive combination of over-the-counter non-steroidal anti-inflammatory medication, cortisone injection(s) into the shoulder, and physical therapy (physiotherapy). Without aggressive treatment, adhesive capsulitis can be permanent.

Diligent physical therapy is often essential for recovery. A physical therapist will administer ultrasound, electric stimulation, range-of-motion exercise maneuvers, stretching, ice packs, and eventually strengthening exercises. Physical therapy can take weeks to months for recovery, depending on the severity of the scarring of the tissues around the shoulder.

It is very important for people with a frozen shoulder to avoid reinjuring the shoulder tissues during the rehabilitation period. These individuals should avoid sudden, jerking motions of or heavy lifting with the affected shoulder.

Sometimes a frozen shoulders is resistant to treatment. Patients with resistant frozen shoulders can be considered for release of the scar tissue by arthroscopic surgery or manipulation of the scarred shoulder under anesthesia. This manipulation is performed to physically break up the scar tissue of the joint capsule. It carries the risk of breaking the arm bone (humerus fracture). It is very important for patients that undergo manipulation to partake in an active exercise program for the shoulder after the procedure. It is only with continued exercise of the shoulder that mobility and function is optimized.

What is the prognosis of a frozen shoulder?

The prognosis of a frozen shoulder depends on its response to physical therapy, exercises, and treatments as described above. Again, it is essential to avoid reinjuring the shoulder tissues during the rehabilitation period. Patients with resistant frozen shoulders can be considered for release of the scar tissue by arthroscopic surgery or manipulation of the scarred shoulder under anesthesia. Without aggressive treatment, a frozen shoulder can be permanent.

Is it possible to prevent a frozen shoulder?

Prevention of a frozen shoulder involves avoiding injury or reinjury to the shoulder.

Medically Reviewed on 7/27/2018
References
REFERENCES:

Doria, Carlo, et al. "Shoulder Adhesive Capsulitis in Type 1 Diabetes Mellitus: A Cross-Sectional Study on 943 Cases in Sardinian People." Joints 5.3 Sept. 2017: 143-146.

Koopman, William, et al., eds. Clinical Primer of Rheumatology. Philadelphia: Lippincott Williams & Wilkins, 2003.

Lee, Kyu Hong, et al. "Adhesive Capsulitis of the Shoulder Joint: Value of Glenohumeral Distance on Magnetic Resonance Arthrography."? Journal of Computer Assisted Tomography 41.1 January 2017: 116-120.

Neviaser, A.S., and R.J. Neviaser. "Adhesive capsulitis of the shoulder." J American Academy Orthop Surg 19.9 Sept. 2011: 536-542.

Ruddy, Shaun, et al., eds. Kelley's Textbook of Rheumatology. Philadelphia: W.B. Saunders Co., 2000.

Zreik, Nasri Hani, et al. "Adhesive capsulitis of the shoulder and diabetes: a meta-analysis of prevalence." Muscles Ligaments Tendons J 6.1 Jan.-Mar. 2016: 26-34.
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