A definition of Adhesive Capsulitis (Stiff Shoulder or Hurt Shoulder)
Adhesive capsulitis is a result of the shoulder joint and the surrounding soft tissue becoming inflamed, swollen and then contracted, or shortened. Over time, bands of scar tissue may start to develop in your joint and connective tissue (muscles, tendons, ligaments) making your shoulder less flexible and restricted in movement. Some people may get to the point where they have no movement at all. If you suffer from adhesive capsulitis you may want to consider using a dynamic splint to aid in your rehabilitation process. A Shoulder Dynasplint® System lengthens the shortened connective tissue and begins to restore your lost range of motion.
Adhesive capsulitis (also commonly referred to as “frozen shoulder”), is a painful condition of the shoulder that results in limited range of motion, as well as discomfort during shoulder movement. In most cases, symptoms begin as mild and progress over time to become more severe.
Symptoms of Adhesive Capsulitis
Typically, the course of frozen shoulder symptoms is divided into three stages:
- Painful stage: Pain occurs with any movement and motion begins to become limited
- Frozen stage: Pain usually decreases during this stage, but mobility worsens
- Thawing stage: Range of motion begins to improve
Each stage may last for several months.
The condition occurs when the capsule of tissue surrounding the bones, ligaments and tendons of the shoulder thickens, scarifies and stiffens, becoming tight around the shoulder and limiting the joint’s ability to move freely.
Currently, the underlying cause of adhesive capsulitis is unknown. However, there are certain risk factors which can increase an individual’s chances of developing the condition. Adhesive capsulitis occurs more frequently in women, and also occurs more frequently in individuals who are over 40 years of age. Because adhesive capsulitis occurs frequently in men and women who are diabetic, some researchers believe an autoimmune response may also be involved in some individuals.
In addition to diabetes, adhesive capsulitis also is associated with other specific underlying diseases, including hyperthyroidism and hypothyroidism (overactive or underactive thyroid, respectively); cardiovascular disease; Parkinson’s disease; and tuberculosis.
Many cases of adhesive capsulitis occur following a period of prolonged immobilization of the joint, usually after surgery or injury, such as an arm fracture, when the arm is kept immobilized. Rotator cuff injury and stroke can also result in immobilization of the arm, which can in turn cause adhesive capsulitis to occur.
Pain associated with adhesive capsulitis may become worse at night, making it more difficult to call asleep or remain asleep.
Adhesive capsulitis is usually diagnosed by a doctor following a detailed physical exam. During the exam, the patient will be asked to perform a series of specific motions, such as raising his or her arms, or reaching across to touch the opposite shoulder. During the exam, the doctor will be evaluating both pain and range of motion. The doctor will also check for rotator injuries, which can also cause shoulder pain and limited mobility. Reflexes, muscle strength and nerve sensation are also usually checked to discount potential nerve damage.
Adhesive Capsulitis Treatment & Therapy
In many cases, adhesive capsulitis can be treated through stretching and other exercises, usually overseen by a physical therapist. In some cases, injections into the joint of steroids or other medications can aid in limiting pain and inflammation. Non-steroidal anti-inflammatory drugs may also be used to reduce both pain and inflammation, especially during the initial painful stage of the condition.
Some individuals may need to undergo surgery or other anesthetized procedures to loosen the capsule and restore range of motion. Several approaches are used to address adhesive capsulitis, including injections of fluids to expand the capsule tissue and improve motion and range of motion procedures, where the shoulder is manipulated in specific ways during a period of general anesthesia to help stretch the capsule tissues. Some individuals may need to undergo arthroscopic surgery to remove adhesions or scars within the capsule that may be preventing healing. Arthroscopy involves tiny incisions and the use of a special instrument, which minimizes pain and speeds healing time following surgery.
Whether or not surgery is used, most individuals will undergo physical therapy to help restore range of motion. In some cases, and especially following surgery, dynamic splinting may be used as an adjunct home therapy to regain range of motion in internal and external rotation as well as shoulder abduction.