Adhesive Capsulitis (Frozen Shoulder)

What is it?

Often referred to as ‘Frozen Shoulder’, adhesive capsulitis refers to inflammation and scarring of the capsule surrounding the shoulder joint.

How does it happen?

The exact reason why adhesive capsulitis develops is not known. However, it tends to occur in the middle aged or older athletes and is believed to be a result from some form of irritation to the shoulder joint and its surrounding capsule. Irritation to the shoulder joint capsule results in an inflammatory response. This inflammation of the shoulder joint capsule is referred to as ‘capsulitis’. Associated with the capsulitis is the formation of adhesions or small scars between folds within the capsule. Consequently, the condition is referred to as adhesive capsulitis.

How does it feel?

The 2 main sensations felt with adhesive capsulitis are pain and loss of movement in the shoulder. The pain may be aching, dull or stabbing, and is most frequently felt deep in the shoulder and over the outside of the upper arm. It is generally aggravated by almost all movements of the shoulder and arm, and its intensity or strength may vary from day-to-day depending on how much you use the arm. The pain is often strong enough to interfere with your normal activities and you may feel it at night when sleeping. The loss of the movement in the shoulder results from the adhesions or scars forming within the joint capsule. These generally develop gradually resulting in a progressive rather than sudden loss in the range of motion in the shoulder. Stretching of these adhesions may aggravate your pain.

What should you do?

If you have or suspect you have adhesive capsulitis, you should consult your nearest sports physiotherapist soon as possible.

What shouldn’t you do?

If you have or suspect you have adhesive capsulitis, you shouldn’t ignore the problem. The longer you leave the condition without treatment the worse it may become. This may make your pain and restriction in movement worse and prolong your recovery.

Could there be any long-term effects?

Adhesive capsulitis usually gets over a number of months and there is little that can be done to accelerate this time frame. Treatment markedly reduces this recovery time. Fortunately, once recovery does occur the long-term outlook is good, unless there is some other underlying condition affecting the shoulder, such as a tear of the rotator cuff.

Management

If the diagnosis of adhesive capsulitis is made, the sports physiotherapist will be able to provide you with an appropriate treatment plan. This will most commonly be aimed at reducing your pain and improving your shoulder range of motion. It may involve the use of anti-inflammatory medications, electrotherapy treatment, and stretching, dry needling, strengthening and range of motion exercises. Occasionally, if these measures do not provide relief, referral from the sports physician for an injection into the shoulder may be appropriate. This is performed by a radiologist. It involves injecting fluid into the shoulder to stretch up the lining of the joint (hydrodilation) and stretches up the restrictive lining of the joint. It is followed up by physiotherapy to ensure that the extra range of motion gained by the procedure is maintained. The procedure also provides significant pain relief.

Tom is a physio in Balgowlah who is highly trained in the assessment and management of all shoulder conditions. For a complete understanding of your shoulder, you will need an assessment face-to-face. To see the most highly regarded physio in Balgowlah, book here.

Brukner & Khan (2012) Clinical Sports Medicine.