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Adhesive capsulitis is the medical term for frozen shoulder which is a condition causing pain and restricted movement in the shoulder joint.
There are three phases that the condition will pass through; a freezing phase where the joint tightens up, a stiff phase where the movement in the shoulder is significantly reduced and a thawing phase where the pain gradually reduces and mobility increases.
Painful (freezing) phase - The freezing phase of frozen shoulder symptoms start with a gradual onset of aching in the shoulder. The pain will often become more widespread and much worse at night making lying on the affected side difficult. This phase can last between 2 and 9 months.
Stiffening (frozen) phase - During the second phase the shoulder joint will begin to stiffen up. The shoulder is likely to be painful still and normal day to day tasks such as dressing or carrying bags become more difficult. Shoulder muscles may start to waste away through lack of use and this may be noticeable. Symptoms during the frozen phase can last between 4 and 12 months.
Thawing phase - During the thawing phase frozen shoulder symptoms begin to improve. Range of movement will increase and there is a gradual decrease in pain although pain may re-appear as stiffness eases for a time. The thawing phase can last 5 to 12 months.
Frozen shoulder or adhesive capsulitis is a condition which affects the ability to move the shoulder usually only occurring on one side. For approximately one person in five the problem spreads to the other shoulder.
The medical term adhesive capsulitis literally describes the condition where adhesive means sticky and capsulitis meaning inflammation of the joint capsule. It is thought that a lot of the symptoms are due to the capsule becoming inflamed and sticking, making the whole joint stiff and difficult to move. This is not the same as arthritis, and no other joints are usually affected.
It is extremely uncommon in young people, and is almost always found in the 40 + age group, usually in the 40-70 age range. Approximately 3% of the population will be affected by this, with slightly higher incidence amongst women, and five times higher prevalence in diabetics.
There are two classifications of adhesive capsulitis:
- Primary - where there is no significant reason for pain or stiffness.
- Secondary - Which follows as a result of an event such as trauma, surgery or illness.
It is not known exactly what causes a frozen shoulder, however it is thought that the lining of the joint (the capsule) becomes inflamed, which causes scar tissue to form. This leaves less room for the humerus or arm bone to move, hence restricting the movement of the joint.
The increased prevalence amongst diabetics (particularly insulin-dependent diabetics) may be due to glucose molecules sticking to the collagen fibres in the joint capsule, which causes stiffness. For this reason, diabetics are more likely to have both shoulders affected. Hormonal changes may be responsible for the higher incidence amongst women, particularly due to the increased prevalence around the menopausal period.
Some studies have shown that poor posture, particularly rounded shoulders, can cause shortening of one of the ligaments of the shoulder, which may also contribute to this condition. Also, prolonged immobility (such as after a fracture) may cause this condition to develop.
What can the athlete do?
Seek medical advice if you think you may have this condition, as early treatment can help prevent really severe stiffness setting in. Follow any advice given by medical professionals, particularly with regard to a rehabilitation program.
Try to keep the shoulder moving even if it is just small pendular movements. If movement is very painful this should be only be done under the guidance of a qualified therapist. Mobility exercises can help keep the shoulder mobile and should be done regularly if pain allows.
What can a Sports injury professional do?
Frozen shoulder is usually managed conservatively, with surgery as a last measure if all other attempts fail. Arrange a course of physiotherapy and exercises which will help maintain mobility and flexibility in the shoulder as best as possible.
A doctor may prescribe oral steroids or anti-inflammatory medication to reduce inflammation in the shoulder joint. Or a direct injection of steroid medication into the joint will also reduce inflammation. If conservative treatment fails to bring about any significant improvement then surgery may be recommended.
Surgery is a last resort if normal treatment has failed. An arthrescopic capsular release is the technique most often used and is done via keyhole surgery. The technique involves dividing the thickened shoulder capsule to release it. It is important that surgery is followed by an aggressive rehabilitation program and the patient sticks to it.
Most cases will resolve on their own or with physiotherapy over a 1-3 year period, however it is a slow recovery process. Some studies have reported positive results following arthroscopic surgery to release the tight capsule, however this is currently only offered to patients who have not improved with conservative treatment.
Many patients have reported persevering with mobility exercises as best they can but the condition just has to work its way through the three phases.