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Adhesive Capsulitis

Adhesive capsulitis is an inflammatory condition that restricts motion in the shoulder. It effects the capsule of a shoulder joint. This includes the ligaments that attach the shoulder bones to each other. When inflammation occurs within the capsule, there is less ability for the shoulder bones to freely move within the joint. The friction caused by this inflammation can cause scar tissue to form further restricting movement.

It is also know as frozen shoulder.

Causes of  Adhesive Capsulitis

The capsule of a shoulder joint includes the ligaments that attach the shoulder bones to each other. When inflammation occurs within the capsule, there is less ability for the shoulder bones to freely move within the joint.

Common causes are

• Diabetes
• Shoulder trauma (including surgery)
• History of open heart surgery
• Hyperthyroidism
• History of cervical disk disease

Symptoms of Adhesive Capsulitis

Pain and stiffness are the main symptoms of this disease.

The disease usually advances in three stages.

• Pain is usually the first symptom this makes the patient not want to move the arm.
• Lack of movement causes stiffness.
• As this stiffness advances there is a loss of motion and function.

In idiopathic frozen shoulder (i.e., frozen shoulder without an identifiable cause), pain is usually the first symptom, which makes the patient reluctant to move the arm. This lack of movement leads to an involuntary stiffness, which is the second phase of the disease. The third phase, thawing, is a gradual return of motion and function.

Diagnosis of Adhesive Capsulitis

• The first step is a physical exam and evaluating the patient's medical history.
• The history should show an extended time of pain and stiffness in the shoulder.
• The doctor will also take note of common risk factors of this condition.
• The doctor will order imaging studies such as an X-ray, CT scan or an MRI to confirm the diagnosis.

Treatment of Adhesive Capsulitis

The basic treatment is with non-steroidal anti-inflammatory medications (such as ibuprofen or Naprosyn) and physical therapy. Unfortunately while this condition nearly always improves with this intervention, it can take as long as 12 to 18 months to see improvement. For results the physical therapy is intense the patient needs to  make sure they do it on a daily basis at home to be successful.

If physical therapy is not successful, or if a patient is unable to tolerate therapy, one of two shoulder surgeries may be performed. The first is a shoulder manipulation, Under anesthesia, the shoulder may be forcibly brought through a range of motion to release the scar tissue. The second is surgery to remove all the sticky scar tissue in the joint. This surgery is usually done arthroscopically. After the surgery it may be necessary to use repeated pain blocks after surgery to allow the patient to painlessly participate in physical therapy after surgery.

Expectations after treatment of Adhesive capsulitis

With therapy and NSAIDs, the problem will usually resolve within a year. When required, surgery is usually successful in restoring motion. Physical therapy is required for several weeks to months after surgery to prevent recurrence. The main  reason for any treatment to fail is non-compliance with therapy.

Complications  of Adhesive Capsulitis

Complications include persistent stiffness and pain despite therapy. If there is forceful manipulation of the shoulder during surgery, the arm can break.

Prevention of Adhesive Capsulitis

The best way to prevent frozen shoulder is to contact your health care provider if you develop shoulder pain that limits your range of motion for an extended period of time. This will allow early treatment and help avoid stiffness, if possible.

Diabetic patients should keep tight control of their blood glucose levels; despite this, they may still develop shoulder stiffness