Adhesive capsulitis of shoulder

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at April 28, 2016
StartDiseasesAdhesive capsulitis of shoulder

Shoulders are among the most complicated joints in the human body. As such, shoulders have unique conditions associated with them. Among the most painful and mysterious is adhesive capsulitis of the shoulder also called frozen shoulder. This condition is a source of extreme pain during active and passive motion and while asleep. However, most patients can overcome frozen shoulder with physical therapy and medication.

Contents

Definition & Facts

Adhesive capsulitis is a condition that causes extreme shoulder pain upon movement and at rest. It is characterized by a stiffening of the shoulder capsule that encloses the connective tissue of the shoulder. Often associated with less synovial fluid in the joint which is the body's natural lubricant for tissues, this is a progressive condition. Left untreated, the condition may quickly progress to inhibit the patient from being able to move the shoulder at all.

Often occurring in people who have had to restrict the movement of that limb for some period of time, frozen shoulder can begin almost silently. However, it often also occurs in people who have not had an immobilized joint, so the immobilization is not a necessary precursor or cause of the condition.

Symptoms & Complaints

The condition usually starts slowly and progresses. Left untreated, the patient may have no ability to move the shoulder at all and may be in pain even without moving it.

Patients generally experience initial levels of mild discomfort when moving the shoulder. This discourages further movement. Rather than the joint recovering via rest, the condition worsens. In time the shoulder hurts even without movement until the patient can't move the joint at all without experiencing extreme pain.

Causes

There are many theories about the cause of frozen shoulder, though medical science does not agree on any single one. Since it is often associated with arm immobilization, some think that keeping the shoulder stationary prevents stimulation of synovial fluid to lubricate the shoulder. The missing lubrication causes pain upon movement. The patient moves the shoulder less because of the pain and in a short time, he or she is in constant pain and can't move the affected shoulder at all.

Almost as frequently, the patient has not experienced joint immobilization, so many consider the above theory unconvincing. There is also a possible link to diabetes or autoimmune diseases, though there is no direct correlation. Theories abound as to the cause of frozen shoulder, but none are accepted universally as the cause.

Diagnosis & Tests

A doctor or medical professional can diagnose adhesive capsulitis of the shoulder from a physical examination. To ensure correct diagnosis and rule out other possibilities, many doctors prescribe analytical testing such as X-rays and MRIs.

For the physical examination, the doctor requests the patient demonstrate the extent of possible motion of the joint. The doctor also passively moves the joint to properly gauge the extent of the restriction. Both the active and passive movement of the shoulder in the examination may cause extreme pain to the patient.

Additional factors the doctor considers are recent joint immobility or recent recuperation periods that may have resulted in little shoulder movement, existence of diabetic and autoimmune conditions, and overall health. Since frozen shoulder is more common among women than men and among those who are over the age of 40, the doctor considers these factors as part of the diagnosis as well.

Treatment & Therapy

There is no single best treatment option, though all involve working the shoulder back into flexibility. Some approaches are:

  • Pain medication: Doctors encourage using over-the-counter or prescription pain medication to reduce pain and facilitate physical therapy.
  • Injection: Some doctors inject the joint with cortisone or sterile water to reduce pain and increase lubrication so the patient can start exercising the joint.
  • Shoulder manipulation: For this treatment, the doctor places the patient under general anesthetic and manipulates the joint to break adhesions that are preventing the shoulder from moving. Once broken, the patient is better able to move the joint and work it back into full mobility.
  • Surgery: For extreme cases a doctor might perform surgery.

In virtually all cases of adhesive capsulitis, treatment focuses on pain reduction to enable movement and recover full use of the shoulder. The recovery process is often described as the transition from winter to spring: first the patient experiences increasing stiffness called "freezing" that progresses to the "frozen" condition, and as it improves it is said to "thaw."

Prevention & Prophylaxis

Prevention of adhesive capsulitis is difficult because risk factors such as age, diabetes and other autoimmune conditions, sex, and immobility of the joint because of an unrelated condition, are not elements that can be prevented.

Because of the link between joint immobilization and adhesive capsulitis, exercising the shoulder during conditions which may inhibit movement may help prevent frozen shoulder. Such conditions which may inhibit mobility could include recovering from surgery or a fracture. Second, becoming knowledgeable of the early symptoms of adhesive capsulitis of the shoulder may contribute to early diagnosis and treatment.