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Frozen shoulder, also known as adhesive capsulitis, is a common condition characterized by pain and limited motions of the shoulder joint. Symptoms usually begin gradually, worsen with time and then resolve on their own, typically within a couple of years.
Anatomy: The shoulder joint is enclosed in a layer of connective tissue, called the shoulder capsule. In frozen shoulder, this capsule is inflamed, thickens and becomes tight. This makes shoulder movements difficult and painful.
Frozen shoulder develops in three stages:
The “freezing” stage is characterized by increasing shoulder pain. The pain is usually felt over the outer shoulder area and sometimes on the upper arm.
The “frozen” stage is marked by progressive loss of shoulder movement, while painful symptoms may actually improve.
In the “thawing” stage, shoulder motions slowly improve. Patients regain most or all shoulder movements, but the process may take months or even years to complete.
Frozen shoulder can be prevented by keeping the shoulder joint fully moving. Often, a shoulder starts to hurt with the onset of inflammation in the capsule. Because pain discourages movement, immobilization subsequently enables scar tissue deposits, which thicken the capsule and freeze the shoulder.
Treatment aims to speed up the natural recovery phase of the disease. The focus of treatment is to control pain and restore motion.
Non-surgical treatments include:
- Non-steroidal anti-inflammatory drugs, steroid injections – to reduce pain and inflammation.
- Physical therapy, stretching exercises – to restore motion range.
Surgical treatments are only recommended when conservative management has failed. These include:
Manipulation under anesthesia: In this procedure, the patient is put to sleep and the shoulder is forced to move in all directions to loosen or rupture the capsule.
Arthroscopic capsular release: In this procedure, the tight portion of the joint capsule is cut using small instruments inserted through keyhole incisions around the shoulder.
