Diagnosing Adhesive Capsulitis
Diagnosing adhesive capsulitis of the shoulder can usually be achieved from the history of the condition and a physical examination of the shoulder joint without any need for investigations.
Examination Features Of A Frozen Shoulder
Classically adhesive capsulitis will have equally limited “active” and “passive” movement. Meaning that the movement the patient can do on their own with their shoulder is the same as what the person examining the shoulder can achieve when they move the patients relaxed shoulder. This is because the limitation is not with the muscles or tendons of the shoulder but due to the capsule of the joint. So movement is limited regardless of the amount of muscle activation or load placed on the shoulder which differs from some other common conditions occurring in the shoulders of fifty year olds such as rotator cuff disorders.
The most limited movements with adhesive capsulitis include:
- Putting your hand behind your back, meaning people will typically notice reaching into their back pocket becomes difficult and doing up their bra behind their back becomes impossible.
- External rotation or rolling your arm outwards is also significantly restricted. This movement can be tested by bending your elbow to 90 degrees and keeping it tucked in to your side whilst trying to roll the wrist outwards away from your body maintaining the same elbow position. With adhesive capsulitis of the shoulder people don’t tend to be capable get their wrist to move away from their body.
- Forward elevation at the shoulder is also limited and functionally makes a lot of basic house hold tasks challenging such as reaching into a cupboard, washing or brusing your hair. With adhesive capsulitis raising the arm up in front of the body is usually limited to around shoulder height.
Treating Adhesive Capsulitis
Effective treatment shortens the duration of symptoms and the disability associated with frozen shoulder.
It is normal to be concerned about the pain, the limited range of movement and associated loss of function with the shoulder. The lost sleep that comes with the condition in the freezing phase due to pain at night certainly doesn’t make coping with a frozen shoulder any easier. However understanding that it is a self limiting condition and the majority of people make a full recovery given time is important.
Common Treatment Approaches For Adhesive Capsulitis:
- Intra articular cortisone injection – anti- inflammatory injection into the joint for targeted reduction of the inflammation associated with a frozen shoulder.
- Hydrodilitation – injection of fluid into the joint to stretch the joint capsule from the inside. This is often coupled with a cortisone injection.
Early use of cortisone coupled with hydrodilitation then follow up physiotherapy and home exercises focused at restoring range of movement, shoulder blade control and strength all performed with in the limits of pain achieves good results and non-operative treatment works for around 90% of patients. If surgery is required then the procedures are manipulation of the shoulder under anesthesia (forced stretching of the shoulder through its full range to restore the movement) or arthroscopic release of the capsule coupled with manipulation of shoulder joint movement.
Disclaimer: Sydney Physio Clinic provides this information as an educational service and is not intended to serve as medical advice. Anyone seeking specific advice or assistance on Treating Adhesive Capsulitis Of The Shoulder should consult his or her general practitioner, physiotherapist or otherwise appropriately skilled practitioner.