Frozen Shoulder (Adhesive Capsulitis)
by Dr Marcus Chia - Shoulder and Elbow Surgeon
Adhesive capsulitis, also known as frozen shoulder, is a common condition involving shoulder pain and loss of motion. Despite the large number of patients affected by this condition, our understanding of the cause is limited. Certain people are predisposed to the development of a frozen shoulder, such as those with diabetes, but in the vast majority of people the cause is unknown. A frozen shoulder can also be seen after an injury or trauma to the shoulder or after a surgical procedure. It is thought to result from a combination of inflammation and fibrosis or scarring. It is a painful and debilitating condition with an often protracted course. Although it is thought that the majority of patients will have complete resolution of symptoms, many people have reported ongoing pain and residual loss of motion.
The most common symptoms of frozen shoulder are pain and loss of motion. The natural history of a frozen shoulder can be described as a continuum of 3 phases, which begins in the painful or “freezing” phase. Typically, pain precedes the restriction in motion. This is followed by the stiff or “frozen” phase, in which the pain gradually decreases but the range of motion continues to worsen. Finally, the recovery or “thawing” phase, in which there is a gradual improvement of shoulder mobility and function. The full duration of the condition can last anywhere from 1 to 3.5 years. Frozen shoulder can affect the opposite shoulder in the subsequent months to years.
A frozen shoulder is always suspected if there is pain and stiffness of the shoulder until proven otherwise. The history and physical examination are essential to differentiate between the stiff and painful shoulder and the true frozen shoulder. Xrays are necessary to exclude other causes.
Treatment for a frozen shoulder almost always includes a trial of conservative therapy. This includes analgesia, supervised physiotherapy and steroid injections. The majority of people will experience resolution when treated in this manner.
If conservative therapy fails to ease the pain and stiffness, Dr Chia may recommend surgery. The surgery will most likely be performed via key-hole (arthroscopic) surgery. During surgery the scar-like tissue around the shoulder is released. The procedure is known as an arthroscopic capsular release. Following surgery, a rehabilitation program under the supervision of a physiotherapist is necessary.
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