Adhesive Capsulitis Overview
The shoulder joint is enveloped by a layer of tissue called the capsule. This capsule protects and controls the maximum shoulder motion. In some patients, especially in patients with diabetes, the capsule may thicken, shorten its length, and become less compliant. This results in a condition known as adhesive capsulitis, often called a frozen shoulder.
Adhesive capsulitis typically starts slowly. Over time, usually weeks or a few months, it makes it hard for the patient to fully move their shoulder. At first, the pain can be very significant, before the motion becomes restricted. Then with time, the shoulder has a dull pain, especially in the extremes of motion, such as when reaching for something on a high shelf or reaching behind your back.
Often, the reason the frozen shoulder occurred is unknown. Some patients try to connect the start of the condition with an unexpected strain to the shoulder. It can happen when the shoulder is immobilized during a recovery period from an arm injury and is more common in middle-aged females and in patients with diabetes. This condition is also linked to thyroid disease and Parkinson’s disease. The condition actually goes away without intervention in most people, but unfortunately this can take more than 2 years.
Frozen Shoulder FAQ
How is frozen shoulder diagnosed?
Frozen shoulder, or adhesive capsulitis, is diagnosed from the patient’s history, followed by a careful physical examination. A few conditions can mimic a frozen shoulder. One such condition is arthritis, which can be diagnosed with a regular set of x-rays of the shoulder. An MRI may be ordered to rule out any other conditions such as early arthritis or rotator cuff disease after the examination and x-rays.
Does sudden limited arm movement mean that I have frozen shoulder?
Maybe. Other possible causes are arthritis, tears in the shoulder labrum, calcium deposits, and rotator cuff tears. Bursitis or rotator cuff tendinitis may also inflame muscles or tendons, causing the joint to “freeze” of feel stiff. Experienced orthopaedic surgeon Dr. Anthony Romeo will make a diagnosis based on patient history, a careful physical examination, and proper X-rays.
Does frozen shoulder require surgery?
Not usually. Studies show that 90% of patients who receive a diagnosis of frozen shoulder will respond and recover from their condition with a regimen of anti-inflammatory medication, corticosteroid injection, and physical therapy directed exercise. Patients with diabetes have a more difficult time resolving the condition without surgery, but nonoperative treatment is always the first line of management.
What are the treatment options?
Exercise & Physical Therapy
Stretching is key. Patients use an elastic cord or overhead pulley to restore the full range-of-motion leading to less pain and better function. The stretching program may be uncomfortable so it is important to have confidence in the diagnosis and understand how movement can resolve the problem.
Your doctor may recommend pain medications because pain can interfere with your ability and motivation to exercise.
When a patient has severe stiffness and pain that stops them from doing physical therapy, a corticosteroid injection into the glenohumeral joint is strongly recommended. It is often suggested—along with physical therapy—on the very first visit as it accelerates the recovery process with no side effects. The one exception is patients with diabetes, who need to carefully monitor their blood sugar for 48 hours after the injection. A cortisone injection can cause a blood sugar spike requiring a temporary adjustment in their insulin therapy or medications. Many patients present to Dr. Romeo concerned about the possible side effects of cortisone, as well as the amount of pain that occurs with the injection. For this condition, side effects for non-diabetic patients are extremely rare and can be treated. With regards to the pain of the injection, Dr. Romeo uses techniques that allow for the injection to pass through the least sensitive areas of your shoulder. Often the injection is completed and the patient will say “Is that it?”.
If a patient is conscientious and committed to daily exercise and physical therapy, range of motion may be restored in three to six months. Final recovery of full range-of-motion is challenging and may take up to one year. If the symptoms continue, however, surgery can be considered.
Frozen Shoulder Surgery (Shoulder Arthroscopy)
In more serious cases that do not respond to nonsurgical treatment, an arthroscopic procedure can be performed. The procedure is done as an outpatient in and ambulatory surgery center and is minimally invasive. The goal of the surgery is to release the inflamed, thickened, and stiff shoulder capsule, as well as debride away inflammation and bursitis when indicated.
During the procedure, a small instrument the size of a pencil, connected to a camera and light source, guides the insertion of a tube and surgical instruments through a small incision in the skin to perform the release of the shoulder capsule and debridement of inflamed tissue. The operation is safe and generally takes less than one hour of surgical time to perform.
Frozen Shoulder Surgery Recovery
An arthroscopic procedure is minimally invasive and done on an outpatient basis, so your recovery from the discomfort of the surgery and effects of the anesthesia should be rapid.
You will be sent home with a sling and instructed to apply ice packs to the shoulder several times a day to reduce swelling and discomfort. Dr. Romeo will give you specific instructions for post-op pain management. The day after surgery, you will be ready to resume physical therapy. This appointment should be set up in advance so that there is no break in the treatment program.
Despite releasing the capsule, the problem does not go away immediately. Even after surgery, sometimes the muscles remember the stiffness and do not want to relax. Therefore, it is critical to push through this challenge for the first six to eight weeks, assisted by your physiotherapist, as well as stretching two to three times per day at home.
The goal of the physical therapy is to reestablish your range of motion, restore flexibility, build muscle strength, and ultimately return your shoulder function to the level you experienced before the frozen shoulder started. Physical therapy and daily stretching exercises also prevents scar tissue from re-forming at the site of the release of the shoulder capsule.
For more information about causes and treatment of frozen shoulder, or advanced treatment options when you have already had surgery and it did not provide the result you were looking for, please request an appointment with experienced Chicago orthopaedic surgeon Dr. Anthony Romeo. Call or email our office today to schedule your visit.
Want to know more? Here a few of Dr. Romeo’s recent medical journal articles about
Adhesive Capsulitis: Demographics and Predictive Factors for Success Following Steroid Injections and Surgical Intervention. Arthroscopy and Sports Medicine Rehabilitation.
Clinical Outcomes of Arthroscopic 360° Capsular Release for Idiopathic Adhesive Capsulitis in the Lateral Decubitus Position. Arthroscopy.
Anatomy of the Shoulder as it relates to Surgery
Anthony Romeo, MD
Dr. Anthony Romeo is one of the nation’s leading orthopaedic surgeons specializing in the management and surgical treatment of shoulder and elbow conditions. His state-of-the-art practice employs minimally-invasive arthroscopic techniques to accelerate the recovery process for a range of challenging conditions.