Adhesive Capsulitis (Frozen Shoulder)
The shoulder joint is enveloped by a layer of tissue called the capsule. This capsule protects and controls the shoulder’s motion. In some patients, especially diabetics, the capsule may thicken and become less compliant. This results in the condition known as frozen shoulder.
This condition is more common in middle aged females and in diabetics. The condition starts slowly and over time makes it hard for the patient to fully move their shoulder. Dull pain can be felt especially in the extremes of motion.
Some other causes for adhesive capsulitis include thyroid disease, Parkinson’s disease and prolonged immobilization.
Adhesive capsulitis is diagnosed on physical exam. An x-ray or MRI may be ordered to rule out any other conditions such as arthritis or rotator cuff disease.
Treatment falls under two categories: physical therapy and surgery. Physical therapy is used to stretch the tissues and restore range of motion. This can be augmented with steroid injections and non-steroidal anti inflammatory medications. Over 90% of patients respond to therapy and most gain back most of their motion. Some patients, however, fail to respond to therapy and require surgery.
Surgery is performed on an outpatient basis using arthroscopic techniques. In the operating room, three small incisions (under ¼” in size) are placed around the shoulder. A camera (arthroscope) is introduced into the shoulder to view the thickened capsule. Using a pair of arthroscopic scissors, the capsule is cut and separated around the entire circumference of the shoulder joint. After the procedure is done, the small incisions are closed with sutures and a sterile dressing is used to cover the shoulder.
Motion is started the day of surgery. A continuous passive motion machine (CPM) may be used after surgery to maintain the range of motion. Physical therapy is also started soon after surgery to prevent the recurrence of the capsulitis.
Print this page.
