Treating Adhesive Capsulitis Of The Shoulder

Diagnosing Adhesive Capsulitis

Diagnosing adhesive capsulitis, which is another name used for the condition commonly called frozen shoulder, can usually be achieved from the history of the condition, meaning the onset of symptoms and their behaviour, followed by a physical examination, without the need for any radiological investigations. It is characterized by significant movement restriction (often painful movement restriction) in the absence of rotator cuff weakness or signs of fracture or osteoarthritis.

The Examination Features Of A Frozen Shoulder

Classically adhesive capsulitis will have equally limited both “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 for them. This is because the limitation is not with the muscles, or tendons of the shoulder, but due to the capsule of the joint. So in a frozen shoulder movement is limited regardless of the amount of muscle activation, or load placed on the shoulder, this differs from some of the other common conditions that may have a similar history of onset occurring in the shoulders of fifty year olds, such as rotator cuff disorders.

Which Movements Are Most Limited With Adhesive Capsulitis:

There are a few classical movement limitations that are generally clearly evident, movement losses that are associated with the capsular pattern of shoulder restriction and sing frozen shoulder to the person examining the patient.

• Trying to putting your hand behind your back is a quick test that can highlight a frozen shoulder. Those who are suffering the pain and stiffness associated with a frozen shoulder will be well aware that reaching into their back pocket is extremely challenging, taking on and off a jacket and doing up a bra behind your back become almost impossible.
• External rotation, or rolling your arm outwards is significantly restricted. This particular 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. With adhesive capsulitis of the shoulder there will be a marked difference between the sides and on the affected side people typically can’t get their wrist to pass much outside the line of their body, at least not without cheating and moving the elbow. either away from their side or straightening it to try and achieve more range.
• Forward elevation at the shoulder is also limited, although this is typically the last movement to become restricted, a loss of range in this movement can functionally makes a lot of seemingly basic house hold tasks challenging. When flexion is lost then activities such as reaching into a cupboard to get a cup from shoulder height, putting on or taking off a jumper, washing and brushing your hair all become a challenge. With adhesive capsulitis raising the arm up in front of the body is usually limited to around shoulder height and clearly this will impact a lot of self care and activities around the home.

Treating Adhesive Capsulitis

It is normal for people 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 the substantial night pain 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 more than satisfactory recovery given time is important. Effective treatment shortens the duration of symptoms and disability associated with frozen shoulder and physiotherapy can play an important role in the management when employed at the appropriate time.

Common Treatment Approaches For Adhesive Capsulitis:

• Physiotherapy
• Anti-inflammatory medications
• Intra articular cortisone injection – this is an anti-inflammatory injection into the joint, and can provide a targeted reduction of the inflammation and pain associated with a frozen shoulder.
• Hydrodilitation – injection of saline fluid into the joint, this is utilized in an attempt to stretch the joint capsule from the inside improving movement and help manage discomfort. This technique is often coupled with an intra-articular cortisone injection.

Early use of cortisone coupled with hydrodilitation then follow up physiotherapy and progressive home exercises focused at restoring range of movement, shoulder blade control and strength all performed with in the limits of pain achieves good results. This non-operative treatment approach is suggested to work in around 90% of patients. If ultimately surgery is required, or elected for, then the procedures available are either a manipulation of the shoulder under anesthesia, or capsular release. Manipulation under anesthesia is the forced stretching of the shoulder through its full range of movement whilst the individual is under a general anesthetic and is used to restore the movement in the joint.  An arthroscopic release of the capsule is often coupled with manipulation of shoulder joint and uses surgery to “cut” capsular adhesions and thickening of the capsule. Both surgical procedures have good outcomes, however come with the potential risk of additional complications, at least more so than conservative treatments like injections and physiotherapy.

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.