FROZEN SHOULDER (Adhesive Capsulitis)

The shoulder is the most mobile joint in the human body. Activities of daily living, including dressing, working, and reaching, require an extensive amount of range of motion. Stiffness in the shoulder can lead to significant difficulty performing daily activities. Adhesive capsulitis (frozen shoulder) leads to a significant loss of motion in the shoulder. There are two types of frozen shoulder:

• Primary adhesive capsulitis: this condition occurs gradually and without injury. Over time, patients start to notice increasing pain and stiffness in the shoulder. Usually, the underlying cause is unknown. In other patients, the cause may be related to an endocrine condition, such as diabetes or a thyroid condition, or other medical condition.
• Secondary adhesive capsulitis: secondary adhesive capsulitis occurs when shoulder stiffness and pain is caused by a known injury or insult to the shoulder. For example, previous surgery, a humerus fracture, or a labral or rotator cuff tear may lead to a very stiff, painful shoulder.

Symptoms

• Sharp pain in the front of the shoulder
• Difficulty rotating the shoulder or elevating the shoulder overhead

Diagnosis And Treatment

Dr. Welch considers each patient’s symptoms, as well as a detailed physical examination to make the diagnosis of frozen shoulder. Frozen shoulder has three distinct phases: the freezing phase, the frozen phase, and the thawing phase. During the freezing phase, the shoulder is very painful and stiff. Any overhead motion or rotatory motion may lead to significant pain. During the frozen phase, the shoulder is much less painful; however it is still very stiff, and patients have difficulty performing normal activities, such as dressing and working. During the thawing phase, patients regain their motion. Most patients recover most or all of their motion over time without surgical intervention. However, it may take months, and on occasion, over one year to regain all motion.

Most patients with a frozen shoulder can be treated successfully without surgery with a dedicated physical therapy program that helps focus on restoring range of motion. Dr. Welch also usually recommends an ultrasound-guided steroid injection into the shoulder joint. A steroid injection helps reduce the swelling and inflammation inside the shoulder so that the patient may progress with physical therapy.

Surgery is rarely required for patients who have a frozen shoulder. If surgery is necessary, Dr. Welch performs a minimally invasive, arthroscopic procedure in which he releases the inflamed capsule of the shoulder. The capsule is a group of ligaments (fibrous tissue) that surrounds the shoulder joint and keeps it stable. In those patients with a frozen shoulder, the capsule is inflamed and scarred. By releasing the scarred tissue, Dr. Welch can help patients regain motion in the shoulder.

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