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Adhesive capsulitis also referred to as "frozen shoulder" is a painful and often debilitating shoulder condition. It is characterized by pain and a gradual loss of active and passive range of motion in more than one direction.

"Frozen" shoulder occurs in 2 to 3% of the normal population over the age of 40 to 60. It tends to be more prevalent in females as well as individuals with type II diabetes. An individual may be at an increased risk of developing adhesive capsulitis if they have a past medical history of diabetes, a thyroid condition, adhesive capsulitis of the opposite shoulder, impingement syndrome in the same shoulder, and/or decreased mobility in the thoracic spine (mid-back).

The condition often progresses very slowly progresses then spontaneously resolves itself. However, some individuals may have residual impairments in the involved upper extremity.

Adhesive capsulitis is characterized as being either primary or secondary. Primary or idiopathic adhesive capsulitis is due to unknown cause. Secondary adhesive capsulitis is caused as a result of trauma or surgery. Researchers have examined the histological appearance of the tissues throughout the slow progression of the condition. As a result of this research they have concluded that adhesive capsulitis consists of four stages. The four stages are as follows: I or initialization stage, II or painful stage ("freezing"), III or adhesive stage ("frozen"), and IIII or resolution ("thawing") stage. The initialization stage can run a course of 0-3 months characterized by severe pain and gradual loss of active and passive range of motion. The painful "freezing". The adhesive "frozen" stage can last anywhere from 9-14 month. Although there is mild pain at this stage, the decreased shoulder range of makes it extremely difficult to function normally. The resolution "thawing" stage typically lasts anywhere from 15-24 months and is characterized by mild pain and a gradual increase in shoulder range of motion and function of the arm. Pain will be present in the shoulder joint itself and may radiate into the lateral arm, elbow, or wrist.

Diagnosis: Adhesive capsulitis can be diagnosed clinically (that is, by an evaluation from a medical professional). Your history and complaints are very important indicators of whether or not you may have adhesive capsulitis. Recovery from adhesive capsulitis can be a long and grueling process. Keep in mind, the condition is a systemic process and it must go through its natural course before it resolves itself. Usually symptoms will spontaneously resolve within six months to one year, unfortunately this is not always the case. Most individuals do not experience residual impairments once the shoulder has "thawed", however a small percentage reports permanent impairments in shoulder motion afterwards.

A patient may say one of the following during the evaluation:




Treatment of Adhesive Capsulitis

Adhesive capsulitis is most commonly treated aggressively and conservatively with the oral-ingestion of NSAIDS (non-steroidal anti-inflammatory drugs) to control inflammation and decrease pain coupled with physical therapy to increase restore normal joint range of motion and decrease pain as much as possible. It may also be treated with cortisone injection(s) to the shoulder joint.

• NSAID’s (Naprosyn, Naproxen, Celebrex, Ibuprofen) - are usually ingested orally. They may be effective for short term, acute episodes of limb pain or numbness associated with a herniated disc. Contrary to patient belief, NSAID’s do not "mask" pain. They actually can have a positive effect on the irritated and inflamed nerve and disc. Many patients with disc herniation may also present with muscle spasms in the muscles of the low back or the buttock. As a result, muscle relaxants (Skelaxin, Flexeril) may also be indicated.
• Cortisone (steroid) injection- consists of injecting a steroid (cortisone derivative) into the shoulder joint itself to decrease inflammation in the capsule. Cortisone injections can help quickly decrease inflammation within the shoulder joint as well as help restore range of motion and function of the involved arm. Patients may receive up to 3 injections within a given year.
• Physical Therapy - The ultimate goal of therapeutic intervention is targeted at increasing multidirectional active and passive range of motion and restoring normal function of the involved arm.

Resources:

Walmsley,S, Rivett, D.A., Osmotherly, P.G. Adhesive capsulitis: establishing consensus on clinical identifiers for stage 1 using the Delphi technique. Physical Therapy Journal of the American Physical Therapy Association. September 2009; 89(9): 906-17.

http://www.diabetesnet.com/diabetes_complications/frozen_shoulder.php