Adhesive capsulitis has become a common problem among the general population which is one of the most common causes of shoulder pain and loss of range of motion. Most of the times, the patients are slowly improving over 12-24 months.
What is adhesive capsulitis?
Frozen shoulder/ adhesive capsulitis is a painful condition which limits both the active and passive range of motion of the shoulder joint (glenohumeral joint) in all the directions.
The functional activities such as dressing, sports activities Lifting things, fastening items behind the back and overhead activities like combing hair, reaching for something in a higher position in a shelf can be limited due to this condition.
Adhesive capsulitis is classified into two types as the primary/idiopathic adhesive capsulitis and the secondary adhesive capsulitis.
In the primary/idiopathic adhesive capsulitis,
When the patient’s pain and loss of range of motion can not be explained by any of systemic conditions or local shoulder disease/injury, it is considered as primary adhesive capsulitis.
In the secondary adhesive capsulitis,
a predisposing factor such as hemiparesis from a stroke, recent surgeries in the thoracic or shoulder region or cervical spondylosis is associated with the patient’s pain and loss of range of motion.
Adhesive capsulitis is consists of 3 stages,
Freezing stage
Frozen stage
Thawing stage
Signs and symptoms of adhesive capsulitis
Freezing stage
Pain - In this stage, the pain is slowly increasing
Pain spread over a wide area of the shoulder and can not express the exact point where the pain is felt (diffuse manner)
Usually worst at night
Exacerbate by lying on the affected shoulder
All the movements of the shoulder become limited
Usually, there is no pain when touching the shoulder (tenderness on palpation)
Frozen stage
Pain - subsides slowly
But still present with the extreme movements
Stiffness with decreased range of motion in the shoulder joint becomes the patient’s main complaint.
Most of the times, the size of the deltoid muscle on the affected side is decreased due to the lack of usage of this muscle (Disuse atrophy).
Thawing stage
Pain - Almost subsided but still can be exacerbated by activities
Range of motion of the shoulder joint becomes almost normal in this stage.
Risk factors for adhesive capsulitis
Age- elder than 40 years
Gender-often prevalent among females
Cervical spondylosis
Immobility or reduced mobility due to reasons such as rotator cuff injury, arm fracture, stroke and recent surgeries in the thoracic or shoulder regions
Systemic diseases such as diabetes mellitus, hyperthyroidism (overactive thyroid), hypothyroidism (underactive thyroid), cardiovascular disease, tuberculosis and Parkinson’s disease
Treatments for adhesive capsulitis
The main goal of the treatment is restoring and maintaining the functions of the shoulder joint. Adhesive capsulitis is a condition in which the treatment is mainly done by physiotherapy. Early diagnosis and following correct modes of treatments tend to avoid unnecessary surgeries.
The patients who have undergone surgeries in thoracic or shoulder regions have a higher risk of ending up with adhesive capsulitis as they are self-limiting the shoulder movements due to the pain. Therefore, following early mobilization and therapeutic exercise to improve range of motion exercises under the guidance of a physiotherapist plays a major role in reducing this risk.
Dilumi Jayaweera
References
Tasto, J.P. and Elias, D.W., 2007. Adhesive capsulitis. Sports medicine and arthroscopy review, 15(4), pp.216-221
Anton, H.A., 1993. Frozen shoulder. Canadian family physician, 39, p.1773.
D’Orsi, G.M. Via, A.G., Frizziero, A. and Olivia, F., 2012. Treatment of adhesive capsulitis: a review. Muscles, ligaments and tendons journal, 2(2),p.70
https://www.mayoclinic.org/diseases-conditions/frozen-shoulder/symptoms-causes/
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