What we treat

Adhesive capsulitis (Frozen Shoulder)

Adhesive capsulitis, or frozen shoulder, is a painful condition which results in a severe loss of motion in the shoulder. It may follow an injury to the shoulder, but may also arise gradually with no warning or injury.

Shoulder Anatomy

The shoulder is made up of three bones: the scapula (shoulder blade), the humerus (upper arm bone) and the clavicle (collarbone). The shoulder joint capsule is a loose bag of tissue that completely surrounds the shoulder joint. The joint capsule is made up of ligaments that form this water tight bag. A ligament is a soft tissue structure made up of connective tissue. Ligaments attach bones to bones. Inside the bag there is a small amount of joint fluid that lubricates the joint surfaces. This bag that makes up the joint capsule has a considerable amount of slack, loose tissue, so that the shoulder is unrestricted as it moves through its rather large range of motion.

Causes of Frozen Shoulder

The shoulder actually "freezes up" due to the severe inflammation of the joint capsule. The loose tissue of the joint capsule that usually allows a great deal of motion at the shoulder sticks together, limiting the motion. Why this should occur all of a sudden is a mystery.

Adhesive capsulitis may begin following other injuries where the shoulder is not moved around normally because of the other injury. A common example is after a wrist fracture, where the arm may be kept in a sling for several weeks. For some reason, this seems to start the process in some people. The condition has also been known to occur after surgical procedures for something unrelated to the shoulder, and even after recovering from a heart attack.

The condition can begin while other shoulder problems are present. Sometimes, problems such as bursitis, impingement syndrome, or a partial rotator cuff tear can lead to a frozen shoulder as well. The pain from the first condition may cause you to decrease the use of the shoulder, and the the underlying condition itself may lead to chronic inflammation. These two things combine to make a dangerous situation to develop adhesive capsulitis . Usually, the adhesive capsulitis must be treated first to regain motion in the shoulder before the underlying problem can be addressed.

Symptoms of Adhesive Capsulitis and Frozen Shoulder
The symptoms are primarily pain and a very reduced range of motion in the joint. The range of motion is the same whether your are trying to move the shoulder under your own power or if someone else is trying to raise the arm for you. There comes a point in each direction of movement where the motion simply stops as if there is something blocking the movement. The shoulder usually hurts when movement reaches the limit of the range of motion, and can be quite painful at night.

Diagnosis of Frozen Shoulder

The diagnosis of adhesive capsulitis is usually made on the history and physical examination. One key finding that can help differentiate adhesive capsulitis from a rotator cuff tear is how the shoulder moves. In adhesive capsulitis the shoulder motion is the same, whether the patient or the osteopath tries to move the arm. In a rotator cuff tear, the patient cannot move the arm, but when someone else lifts the arm it can be moved in a nearly normal range of motion. X-rays are usually not helpful. An MRI may show that the shoulder capsule is scarred and contracted. An MRI scan is a special radiological test where magnetic waves are used to create pictures that look like slices of the shoulder. The MRI scan shows more than the bones of the shoulder. It can show the tendons as well, and whether there has been a tear in those tendons.

Treatment of Frozen Shoulder

Treatment of the frozen shoulder can be frustrating and slow. Most cases will improve more quickly with regular osteopathic treatment. Depending on the stage of development of the condition you can expect it to take between 4 to 13 treatments to resolve. Some cases of trauma can make the treatment longer. Anti-inflammatory medications and dry needling of the shoulder muscles can be useful. It is critical that a program of treatment and exercises be started and continued to regain the loss of motion.

Some doctors offer an injection of cortisone and long-acting anesthetic. This may bring the inflammation under control, and allow the stretching program to be more effective but is not always effective.

by John Chaffey - Osteopath last review Nov 2012