Adhesive Capsulitis / Frozen Shoulder
Adhesive capsulitis, often called frozen shoulder, is a condition where the capsule (lining) of the glenohumeral joint becomes thickened and tightens producing shoulder pain and stiffness. It can be caused by trauma (including operations to the shoulder), but it also can occur without injury. It is more common in people who have diabetes, and also associated with other conditions such as heart disease.
Adhesive capsulitis has three phases, which do merge:
- Freezing phase – Development of pain and progressive stiffening of the shoulder over a period, usually from 3 to 9 months.
- Frozen phase – Pain gradually improves although there is relatively little or no improvement in motion. The frozen phase usually lasts from between 4 to 12 months.
- Thawing phase – Motion improves as does residual pain, typically taking another 12 to 24 months to increase maximally.
A large number of people suffering from a frozen shoulder make a full recovery, but 40% of people are left with some degree of stiffness or discomfort, although it is typically mild. It is good that adhesive capsulitis generally resolves itself, but it is very annoying that the time span is so long for a condition which is frequently sore and reduces function dramatically for a long period.
Patients who have had shoulder surgery will inevitably have some shoulder stiffness, which will gradually resolve over some months. Some postoperative patient will have a sufficiently stiff shoulder to be considered frozen. This should improve gradually over time and may be assisted by some of the treatments in this section.
Frozen Shoulder Treatment
Non Operative Treatment
There are some treatments that can be considered for frozen shoulder. It is commonly painful, and therefore having adequate painkillers is sensible. In the freezing phases gentle physiotherapy to keep the shoulder mobile can be of help, although activities which increase shoulder pain should be avoided. If adhesive capsulitis is identified in the first few weeks, then a steroid injection into your glenohumeral joint may be particularly useful. If your adhesive capsulitis is more long standing, then a steroid injection into your glenohumeral joint, or an injection called hydrodilitation which is undertaken by the radiology doctors, and consists of an injection of steroid and some saline (salty water) under modest pressure to stretch out the capsule, can lead to improvement for many patients.
If injection of the shoulder is insufficient to improve matters then an arthroscopic operation to release areas of the shoulder capsule (arthroscopic capsular release), followed by an intensive course of physiotherapy is usually helpful in speeding up recovery. Exercises and physiotherapy after surgery are vital, as surgery for adhesive capsulitis only frees the capsule to allow movement for exercises to help regain motion. The risks and recovery process are similar to that of subacromial decompression (please see this section), but the physiotherapy is of particular importance after arthroscopic capsular release. A discussion of surgical risks is included in this booklet. Please read that section before your operation.