Adhesive Capsulitis (Frozen shoulder): Diagnosis & Treatment

Adhesive capsulitis or Frozen shoulder is a common cause of shoulder pain. As the name suggests it is condition in which the capsule of the shoulder joint gets inflamed and strongly stuck (as in vacuum sealed consumer products) to the bones of the shoulder joint. Inflammation and thickening of the capsule cause this.

Symptoms include pain and stiffness in the affected shoulder. Pain is limited to the shoulder and does not radiate to the forearm. Movements of the shoulder are decreased. Hence it is also known as Frozen Shoulder.

Patients complain of difficulty in combing hair, scratching the back and wearing clothes. Women find it difficult to hook their bra. Usually patients are above forty years of age.

It has found to be more common in patients of Diabetes Mellitus and Cardio Respiratory disease.

It can be divided into two types
  • Primary or Idiopathic, in which no cause can be determined
  • Secondary to an injury of the shoulder
Natural history of the primary type has three stages.

STAGE 1 - Pain is present in the shoulder area. Movements are painful, so the patient avoids using the shoulder. This leads to stiffness.

STAGE 2 - Stiffness gradually increases. Activities of daily living become difficult. A dull ache is present all the time in the shoulder. This stage lasts for 6 to 8 months.

STAGE 3 - Pain gradually subsides. Movement returns. This stage lasts for 4 to 6 months.

In the secondary type patient gives a history of trauma to the shoulder joint. Following trauma patient limits the use of his shoulder. Pain subsides and stiffness develops.

Diagnosis of adhesive capsulitis is mainly based on history and physical examination. Routine x rays of the shoulder are normal.

Confirmation of diagnosis can be done by Arthrography. In this procedure a dye is injected into the shoulder joint and a x ray is taken. A low volume of less than 15 ml and lack of filling of the inferior pouch is confirmatory. Arthrography is rarely required as the diagnosis is pretty obvious clinically.

As adhesive capsulitis is a self limiting disease (it recovers on its own in 18 to 24 months), therefore aggressive treatment is hardly ever required. If the pain is not bothersome then simple reassurance of gradual self recovery is all that is required. Otherwise treatment methods to minimise pain are used. These include

  • NSAIDs (drugs such as aspirin, diclofenac and ibuprofen)
  • heat (hot water bottle, infra red lamp)
  • injection of long acting steroid into the shoulder joint
  • Hyaluronan injections in the joint
Sometimes patients don't want to wait for spontaneous recovery. In these patients I use the following therapies.

  • Forceful injection of 50ml saline in the shoulder joint. This distends the capsule and breaks the adhesions
  • Manipulation under general anesthesia.
  • Injection of steroid in to the shoulder joint to reduce inflammation and pain.

After this the patient is advised to undergo an active physiotherapy program to maintain and increase the range of motion of the shoulder joint. At times I use different combinations of the above methods.

Frequently Asked Questions

What if I have tingling, burning, and numbness along with pain in the shoulder? Can it still be adhesive capsulitis?

If you have tingling, burning, and numbness along with pain in the shoulder (but no stiffness) you probably have Cervical Spondylitis, which is a disease of the nerves and not the shoulder joint.

If stiffness is present in the shoulder along with pain, tingling, burning and numbness then you probably have both Cervical Spondylitis and Frozen Shoulder. Both occur in the same age group.

Can the disease involve both shoulders?

Yes it can, but usually one at a time.

I am diabetic taking insulin and have good blood glucose control; can I still develop frozen shoulder?

Yes you can. Development of the disease is independent of blood glucose levels in diabetics.

Can I expect full recovery if I don't take any treatment?

Yes full recovery is possible even if you don't take any treatment as the disease is self limiting.

I hope the information provided was helpful. If you have any query you can ask me at the contact me page.

This page was last updated on 23rd September 2010.

Other causes of shoulder pain...

Subacromial Bursitis

Bicipital Tendinitis

Rotator Cuff Tendinitis

Shoulder Dislocation

Recurrent Shoulder Dislocation

Shoulder Fracture

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