Frozen Shoulder or Adhesive Capsulitis

What is it?

Frozen shoulder or adhesive capsulitis is a condition in which the shoulder becomes painful and stiff. This occurs through three phases:

  • Painful freezing phase : duration 10-36 weeks. Pain and stiffness around the shoulder with a constant nagging pain at night, with little response to painkillers.
  • Adhesive phase : Occurs at 4-12 months. The pain gradually subsides but the stiffness remains. Pain is present mainly at the extremes of movement. There is a global reduction in movements, with almost complete obliteration of external rotation.
  • Resolution phase : Takes 12-42 months with gradual return of movement.

What are the causes?

It is thought to be caused by scar-like tissue (adhesions) forming in the shoulder joint. In the vast majority of cases the condition is idiopathic, without obvious cause. It seems that people with diabetes have an increased risk of developing frozen shoulder. It is more common in women and it is rare under the age of 40.

How is it diagnosed?

Frozen shoulder is diagnosed by a clinical examination although X-rays may be useful to rule out other causes.

How is it treated?

Treatment of frozen shoulder should be tailored to the stage of the disease.

During the initial painful freezing stages, treatment is directed at pain relief. A combination of analgesics, steroid injections and physiotherapy may be effective.

In the later adhesive phase, more aggressive stretching exercises will be tolerated and should be the focus of treatment, with the aim of regaining the range of motion.

In cases of severe, resistent frozen shoulder, surgery may be considered to release the contracted capsule and regain motion. The surgery is performed arthroscopically usually as a day case.