FROZEN (ADHESIVE CAPSULITIS)

Jerry Barclay, PT, BSC

Kaiser Permanente - Staff Physical Therapist, San Diego, CA.

Frozen shoulder also called adhesive capsulitis is a common shoulder problem which results in substantial and very slowly resolving stiffness and loss of shoulder motion. Simple functions such as washing your hair, putting on a blouse or jacket, or tucking your shirt into your slacks can become difficult and painful.

No one really knows the causes of frozen shoulder but it is well known that this doesn’t happen in any other joint of the body. The process can begin for no reason but often happens after a shoulder or surgery when the shoulder has not moved normally for a while. For unknown reasons frozen shoulder is more frequent and often more severe in people with diabetes, thyroid conditions, and in post-menopausal women. This disorder usually occurs between the ages of 40 and 60 and 70% of the cases occur in women. It is usually not associated with calcium deposits or , and often x-rays are completely normal.

The loss of motion usually has a pattern. There is usually loss of flexion or reaching forward overhead. Loss of abduction or reaching overhead from the side is usually worse than flexion. External rotation or reaching backwards in a throwing motion is often the worst most limited and painful position. Frozen shoulder is a self-limiting condition which means it usually fully resolves in time.

Frozen shoulder usually happens in three phases. Each phase lasts approximately 3-5 months. Typically the condition lasts from 8 to 18 months although it can take up to three years to resolve in the most severe cases.

The first phase, “freezing phase “is usually very painful. This pain limits the shoulder’s range of motion and the shoulder can get progressively stiffer and stiffer. During this phase cortisone injections and /anti-inflammatory medications are often helpful. Ice, moist heat and physical therapy modalities may be helpful as well. Physical therapy will usually teach patients home exercise programs of gentle stretches which are often best done for short periods of time very frequently. Excessive stretching and straining to increasing motion can make the symptoms worse. Frequent physical therapy visits for stretches and mobilizations in the clinic are usually of limited value.

The second phase, “frozen phase”, usually hurts much less. The shoulder is just stiff. It doesn’t get worse and the patient often learns to function a bit better. At this phase continued stretching at home and occasional therapy visits about 1 x a month to monitor progress is recommended.

In the third and final phase the shoulder gradually regains full motion and function. Therapy here can greatly help the patient regain full function, full motion, and normal strength. Surgical treatments such as manipulating the shoulder or even arthroscopy should be approached with substantial caution since the frozen shoulder usually improves with conservative care.

The frozen shoulder is a curious and perplexing problem that often causes substantial frustration for patients, therapists, and . Fortunately, it is a self-limiting process and often improves with a tincture of time, patience, and conservative treatment.