Adhesive Capsulitis
Adhesive Capsulitis or "Frozen Shoulder" is a condition that is severely painful and leads to a significant loss of shoulder motion. The cause can be injury, surgery, illness, or unknown. The layer of the shoulder beneath the rotator cuff is called the capsule. The capsule helps to provide the stability of the shoulder, but it is redundant enough to allow for the motion needed for normal or sports activity. When this capsule is inflamed, the shoulder obviously suffers with loss of motion.
The initial phase of frozen shoulder is the capsule or inner liningbecomes inflamed which leads to significant pain with motion or loss of normal motion. This initial phase is treated with adequate pain control, steroid injections ( 1 or 2), and rest. The second phase leads to resolution of the inflammation; however, the capsule shrinks or shortens leading to a stiff or "frozen shoulder." This phase is usually the time patients seek help secondary to severe loss of motion. The treatment is focused on specific physical therapy to treat this loss of motion. Pain control and Nonsteroidals can be used. In the third phase the capsule scarring resolves and the motion and the pain are returned to normal.
Adhesive Capsulitis can be a 12-18 month process with conservative management. Surgical intervention after the acute inflammation phase can accelerate the return to normal motion and strength of the shoulder. Manipulation of the shoulder with the patient asleep, tears the capsule which can lead to increased motion. Surgery includes a precise arthroscopic release of the portions of the capsule that are scarred or shortened. Following surgery, aggressive physical therapy helps maintain the motion and return of normal strength. Diabetes and prior surgery patients have less predictable good results.
With a precise diagnosis and treatment aimed at the specific phase of the condition, we can successfully treat adhesive capsulitis. The process of possible surgery, aggressive physical therapy, and return to normal function can still take a great deal of time.
