Adhesive capsulitis or frozen shoulder is a condition affecting range of motion in the shoulder, and for which doctors fail to have an exact explanation of why it occurs. The condition has three stages: an early pain stage, where the shoulder feels painful and pain may inhibit range of motion of the shoulder, the frozen stage where shoulder movement may be very limited, and thawing stage when some range of motion is restored to the affected shoulder. Frozen shoulder tends to most commonly occur in people over 40, and may be more common among people with autoimmune diseases, thyroid problems, heart disease, and diabetes.
What’s really occurring when you have frozen shoulder is inflammation of the shoulder capsule, which is the connective tissue between the humerus (arm bone) and the shoulder bone (scapula). The swelling can reduce the normal amounts of fluid present to lubricate joints, which results in reduced ability to move the joint. Frozen shoulder usually affects only one shoulder but it can significantly and sometimes permanently impair movement to the point where it is almost impossible to do simple routine tasks, like moving a fork to your mouth or brushing your hair.
Initial symptoms of the condition, during the painful stage, definitely suggest a visit to your physician. Some physicians believe that earlier diagnosis of frozen shoulder is advantageous because a physical therapy regimen can immediately begin. This may help restore greater range of motion to the shoulder. Even when patients reach the thawing stage, not all range of motion will be restored to the affected joint, arm and shoulder. Early intervention bodes well for better recovery from this condition.
If your doctor suspects frozen shoulder, he or she will probably gain the most information by a simple physical exam to check your range of motion. Medical history, especially to check for any of the above mentioned conditions, will be considered and your doctor may also order x-rays or a magnetic resonance imaging (MRI) test to specifically evaluate inflammation of the shoulder capsule. When diagnosis is confirmed, doctors usually refer patients to physical therapists to start immediately on range of motion exercises that can help restore greater function to the shoulder joint.
To address pain, doctors may consider prescribing non-steroidal anti-inflammatory (NSAIDS) medications like ibuprofen or naproxen sodium, or other NSAIDS only available by prescription. To treat immediate pain, some doctors do inject steroids into the shoulder joint, but this treatment isn’t always recommended, and especially should not be repeated often. Some steroids may actually cause more harm to the shoulder joint, particularly if used frequently. Doctors may also prescribe alternating use of heat and cold to help alleviate inflammation. A few doctors recommend surgery to remove scar tissue from the shoulder joint.
Another possible treatment method for frozen shoulder is transcutaneous electrical nerve stimulation. This treatment basically delivers tiny bursts of electricity along affected nerves via electrodes that are taped to your skin. It is thought this treatment may stimulate production of endorphins and relieve some pain. It won’t overall increase range of motion, but may be tried when patients are significantly affected during the pain stage.
The key to recovery from frozen shoulder is to keep maintaining as much movement in the affected shoulder as possible. Patients are advised to adhere to all recommendations by a physical therapist and to do any proposed exercises and stretches on schedule. Usually it is patients who don’t seek treatment that end up with significant impairment of the shoulder joint. To prevent this, zealously follow the exercise schedule your doctor or physical therapist suggests and keep, as pain or lack thereof permits, attempting to move the shoulder as much as possible. Even with rehabilitative therapy, some impairment of the joint may remain, but with carefully guided exercise, you have greatest likelihood of restoring greater range of motion and getting back the use of your arm and shoulder.
