Adhesive Capsulitis – “Frozen Shoulder”

Causes

A “frozen shoulder” is an inflammation of the articular capsule of the shoulder joint (formal name – adhesive capsulitis). It occurs most often (but not exclusively) in women between 40 and 50 years of age. The causes of adhesive capsulitis are not fully known. We know that “frozen shoulder” is more common in people with diabetes, thyroid hormone abnormalities, as well as high cholesterol and heart disease. However, the disease can, in practice, affect almost anyone. Sometimes the initiating factor may be a minor trauma or overstrain. In other cases, the disease progresses spontaneously.

Symptoms of  “frozen shoulder”

The “frozen shoulder” condition has three stages:

  1. “Freezing” – this stage lasts from 3 to 6 months and is characterized by severe pain. Over time, there is a limitation in the range of motion of the joint.
  2. “Freeze” – this stage lasts from 3 to 10 months and is characterized by a gradual reduction in pain, but by a persistent significant reduction in joint mobility.
  3. “Defrosting” – this stage lasts from 6 to 24 months. The range of motion of the joint gradually begins to return to normal.

Diagnosis

The history of the appearance of symptoms, the patient’s age, limited range of motion in certain directions and joint crepitation during the clinical examination allow for a preliminary diagnosis. Osteoarthritis is easily confused with a “frozen shoulder”, hence it is necessary to perform an X-ray, where the degenerative changes are perfectly visible. In case of doubts or planning surgery, I additionally recommend magnetic resonance imaging or computed tomography.

Treatment

In more than 80% of cases, the disease resolves spontaneously after 12-24 months and only requires supportive treatment, including:

  • painkillers and anti-inflammatory drugs,
  • rehabilitation – strengthening exercises and gentle stretching within pain limits,
  • corticosteroid injections – reduce inflammation and can speed up the resolution of the disease.

If symptoms persist despite conservative treatment, arthroscopic capsular release surgery should be considered. It is a minimally invasive treatment (2-3 skin incisions) performed under general anesthesia. The procedure can significantly reduce pain and improve range of motion in most patients. It is associated with a small risk, including recurrence of a medical condition or infection. The operation takes approximately 45 minutes. Returning to everyday life activities, e.g. driving a car, depends on the degree of pain and may last from 1 to 8 weeks. The full recovery period takes 4 to 12 months.

 

dr n. med. Tomasz Kowalski

Specjalista ortopedii i traumatologii narządu ruchu

Jestem Zastępcą Ordynatora Oddziału Ortopedii i Traumatologii Narządu Ruchu w Carolina Medical Center oraz pełnię funkcję Kierownika Medycznego Bloku Operacyjnego. Specjalizuję się w leczeniu schorzeń stawu barkowego, łokciowego oraz kolanowego. Wykonuję pełen zakres zabiegów operacyjnych włączając operacje artroskopowe, rekonstrukcje pourazowe oraz endoprotezoplastyki. Zajmuję się również leczeniem urazów narządu ruchu (złamań, zwichnięć, zerwań mięśni i ścięgien) u dzieci i dorosłych.