There are many different types of conditions that can affect the shoulder. Adhesive capsulitis is one of those conditions and it is the fancy medical term for what is more commonly known as frozen shoulder. First – a little anatomy lesson first so that we are all on the same page. The shoulder, or glenohumeral joint, is made up of the humeral head and the glenoid of the scapula. These two bones come together to form a ball and socket joint which is normally able to accommodate about 180 degrees of overhead motion when functioning properly. To help these bones glide smoothly, there is a substance within the joint called synovial fluid. Surrounding the joint are several different structures including muscles/tendons, the labrum, and the joint capsule. The joint capsule is made up of strong fibers that help keep our shoulder stable while still allowing movement.

shoulder anatomy to display where adhesive capsulitis occursshowing extension and flexion range of motion present in shoulders without symptoms of adhesive capsulitis

What is Adhesive Capsulitis?

So, what exactly is Adhesive Capsulitis and why does it happen? Sometimes it can happen as a result of an injury or immobilization after surgery, but often times, there is not an exact known reason for its onset. Frozen shoulder occurs when there is inflammation and thickening of the fibrous joint capsule surrounding the shoulder. Adhesions and scars form, causing the capsule to become stiff and tight. The synovial fluid within the joint also decreases. The decreased fluid and stiff capsule leads to the so called “frozen” shoulder.

a normal shoulder and a frozen shoulder due to adhesive capsulitis

Stages of Adhesive Capsulitis

The good news is that this condition will generally resolve over time. An important thing to understand about frozen shoulder is that it starts gradually and has a staged progression that can last anywhere from 9-24 months (sometimes longer, sometimes shorter.) There are four stages of of adhesive capsulitis;

  • Stage 1: Freezing
    • During this stage which can last anywhere from 1-9 months (or longer), movement will be painful and you will begin to notice a loss of motion, especially when reaching overhead, behind your back, or behind your head. Patients often try to limit their shoulder motion by using it less – because it’s painful. Pain is the trademark of this phase, usually both day and night.
  • Stage 2: Frozen
    • By the beginning of the ‘frozen’ stage, you will likely have been experiencing stage 1 symptoms for at least 9-14 months. Your shoulder will likely have a substantial loss of range of motion accompanied by pain. However, pain will typically begin to lessen by the end of this phase in your immediate range of motion, worsening when the far limits of flexion and extension are reached.
  • Stage 3: Thawing
    • The shoulder begins to ‘thaw’ after about 12-15 months. Thawing is usually simple to identify because there is a great decrease in pain, specifically at night. Range of motion is still limited, but you will notice rapid improvements in your ability to complete day to day activities that involve some degree of overhead motion. It can be a slow process, but for most, the residual pain and stiffness in your shoulder does not limit them from participating in their normal, functional activities.

Diagnosing a Frozen Shoulder

Care is often sought during the ‘frozen’ stage of adhesive capsulitis, sometimes well into the freezing stage. Most are seen with the complaint of generalized shoulder pain and stiffness. Your physical therapist will perform a free injury screening to thoroughly assess the injury, evaluate your medical history to rule out other potential diagnosis, and offer next steps. Your physical therapist will be looking for a particular pattern called the ‘capsular pattern’ – which is the hallmark way range of motion is lost with a case of adhesive capsulitis. Additionally, your physical therapist will consider alternate or contributing diagnoses, diabetes, hyperthyroidism, hypothyroidism, cardiovascular disease, Parkinson’s disease, and tuberculosis.

How will physical therapy help my frozen shoulder?

Although frozen shoulder is a condition that usually must run its course, there are still many treatments that can assist in improving range of motion and help alleviate the pain. Conservative management is the best initial step in addressing a frozen shoulder. Physical therapists can help provide you with the appropriate exercises for whatever phase you are in. Exercises may include light mobility or stretching, strengthening, manual joint mobilizations to assist in increasing range of motion, a customized at-home exercise program, and various modalities to assist in decreasing pain levels.

Overall, we will work with you to identify your various functional goals, whether it be being able reach into the top shelves in your home or to get back on the golf course. Other forms of treatment that may be combined with physical therapy include use of anti-inflammatory medications, corticosteroid injections, or surgical interventions. These options can be further discussed with your primary care physician or the MD overseeing your care.

If you think you have a frozen shoulder or are experiencing other aches and pains in the shoulder or other joints, visit one of the Axes Physical Therapy locations near you so we can get you back to doing what you love!

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