Adhesive capsulitis is defined as a restriction of motion to a joint. While any joint can be affected, the shoulder joint is most commonly involved. Adhesive capsulitis is often referred to as a “frozen shoulder”.
Onset of symptoms can be rapid in nature or can occur over an extended period of time and are often accompanied by pain. One may develop restriction of motion to the shoulder after direct trauma or after an injury to an adjacent body part. For example, a wrist fracture treated in a sling or cast can often cause immobilization to the shoulder region, resulting in adhesive capsulitis.
Symptoms of adhesive capsulitis include limitation of motion, weakness and often pain. These symptoms can get worse within a short period of time, but often progress slowly over several months. Certain motions of the shoulder will often be affected more than others, such as forward flexion and abduction.
Adhesive capsulitis is diagnosed with clinical examination, which includes checking which motions have restriction and/or cause pain.
Strength testing is also important in evaluating the degree of rotator cuff weakness.
X-rays are often taken to rule-out fractures, dislocations, tumors, calcific deposits, osteoarthritis and to evaluate for bone spurs. MRI’s may be ordered to rule-out a rotator cuff tear.
Treatment focuses on following a diligent stretching protocol with a certified physical therapist to regain range of motion.
If pain is present, icing, anti-inflammatory medications and activity restrictions may be advised. Return of motion can be slow, often requiring several months of treatment.
If conservative measures fail to show improvement, then one may consider manipulation of the shoulder under general anesthesia. Rarely, this may include arthroscopic debridement and release of the capsule. The end result is usually improvement of function with good range of motion and strength.