Adhesive capsulitis (frozen shoulder) is a debilitating condition of the shoulder characterized by a period of acute shoulder pain followed by a period of increasing stiffness, most marked in external rotation, before eventual thawing. This typically resolves over a period of between 12 -30 months with minimal functional deficit, but there may be some restrictions in shoulder range of motion at the extremes. It almost never effects the same shoulder twice but approximately 20% of patients will experience a frozen shoulder of their other side in their lifetime. It is caused by inflammation of the shoulder capsule and ligaments followed by their thickening and scarring, particularly in the rotator interval. It is most common in middle aged women, and people with diabetes. Those with diabetes frequently experience a more severe and prolonged course of the disease with greater residual stiffness. It may also follow other shoulder conditions such as shoulder fracture or surgery.
During the acute painful stage, inflammatory shoulder pain will disturb the patient throughout the day and even more so at night. It can be hard to diagnose at this stage before the classical stiffness has developed. It is during this stage however that an ultrasound guided intraarticular corticosteroid injection is most beneficial. Treatment otherwise consists of analgesics, particularly regular paracetamol and anti-inflammatories such as ibuprofen.
The stiffening phase is characterized by increasing active and passive (not helped when pushed by other arm) loss of range of motion in all planes, but most marked in external rotation. The constant pain will usually resolve soon after the start of the stiffening phase, but you will feel pain at the limits of your range of motion. This can make it difficult to do many everyday chores, and women usually are unable to reach around to apply their bra strap. The general recommendation is to try and maintain function and range of motion in the shoulder with gentle stretching exercises, particularly during a warm shower in the morning and evening. Painful forced stretching should be avoided. Thawing typically starts after 12 months with slow improvement in the range of motion.
With a positive natural history, most patients will be treated non-operatively. Arthroscopic (key hole) capsular release is an option for those patients who have had the condition for more than 4-6 months (no longer in acute painful inflammatory stage) and in whom the loss of range of motion is interfering with either their work or personal life to such an extent that the risks of surgery are justified for a faster return of range of motion. It is also a good option if the thawing phase has not commenced by 18 months post onset.
Dr Hamish Rae, one of the best shoulder surgeons in Sydney, can offer you more information about your shoulder pain and options for treatment. To make an appointment with this orthopaedic specialist please call 80055111.