Addhesive capsulitis of the shoulder is a very common disorder that in layman's terms is known as frozen shoulder.
It is poorly understood with the main reason being that it's difficult to truly define what it is and to separate out from other diagnoses with similar findings and patient symptoms.
It is tough to not only define frozen shoulder, but also difficult to explain it and treat it.
Adhesive capsulitis is typically known as a self-limiting diagnosis that resolves over a period of one to 3 years.
It is quite unbelievable that a person may be afflicted with the condition that doesn't simply resolve itself over a few weeks to months but actually takes years! There are some doctors who believe that up to half of patients with the problem did not respond the conservative therapies over the long term.
With frozen shoulder individuals end up having reduced range of motion both actively and passively along with substantial pain in that shoulder.
When classifying the shoulder that is frozen, it should be placed into a category of either a primary issue or a secondary diagnosis.
If it is primary, it is called idiopathic as it is unclear what led to the problem.
If it is secondary, there is an underlying problem such as a biceps tendon tear, a rotator cuff tear, or something else in the shoulder that led to the reduced range of motion and pain.
There have been numerous research studies looking at shoulders with adhesive capsulitis.
Studies have broken the disorder into numerous phases.
Phase 1 is a period of information, increasing pain, and stiffness that gets worse and this last for upwards of 9 months.
The next phase is where the pain starts to lessen and the stiffness actually gets worse and this can last for approximately a year.
The next phase is when the shoulder actually starts to thaw out and the range of motion gets better and this may take upwards of 1 to 3 years.
As the problem is beginning, one of the main issues experienced is inflammation inside the joint known as synovitis.
This inflammation causes the capsule around the shoulder joint to get larger and thicken and this can lead to the reduction in range of motion.
The causes for adhesive capsulitis are theoretical and have been postulated to be issues with rotator cuff pathology, biceps tendon tears, or maybe an autoimmune disorder.
The premise is that we really don't know what causes it and that's what makes it very confusing.
When a patient goes to see an orthopedic surgeon with a frozen shoulder, typically they report a gradual onset of the pain that was sparked up by what seemed to be an innocuous incident.
This may be reaching behind them in the car to get something out of backseat, or someone may be pulling on their arm mildly.
Patients may have some swelling around the shoulder with difficulty performing overhead activities.
Individuals with diabetes have a substantially higher incidence of shoulders that are frozen than otherwise, especially if they've been taking insulin for over a decade.
The goal with patients who have a shoulder that is frozen is to decrease the pain and get the range of motion back to where was before.
Initially, treatment consists of physical therapy, anti-inflammatory medications, attend unit, and steroid injections.
Prescribing the contexts for adhesive capsulitis is not a great idea on a chronic basis.
Increasing range of motion through physical therapy has been shown in studies to help a lot and giving a steroid injection can improve the benefits as well.
A home program with physical therapy is pretty much mandatory and should be done 4 to 5 times a day.
It only takes about 10 min.
and can help increase range of motion which is much better than simply doing it once per day.
There is another procedure that is utilized whereby fluid is injected into the shoulder under pressure to try and disrupt the tight capsule.
This can be done by itself or it can be done along with the manipulation.
A manipulation under anesthesia has been the best operative treatment for a frozen shoulder.
The patient receives sedation and this allows the shoulder to be manipulated and break up the scar tissue.
The shoulder range of motion is able to be restored quickly and this procedure should be considered if 3 to 6 months of conservative treatment fail.
A manipulation under anesthesia should not be performed however, if the patient is in that initial phase with a lot of inflammation and pain.
The procedure overall has been shown to be safe and effective.
There are some complications that can occur such as anesthesia complications or an actual fracture of the shoulder if the manipulation is too forceful.
A rotator cuff tear can occur as well.
Beyond manipulation under anesthesia, there are some open arthroscopy techniques or incisional types of surgery to free up the tight capsule to increase a patient's range of motion.
Overall, frozen shoulder is a self-limited disease and gets better over a period of 6 months to 3 years.
Unfortunately it's not a few weeks but takes quite a while to improve.