What is adhesive capsulitis?

What is adhesive capsulitis?

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Adhesive capsulitis, commonly known as frozen shoulder or periarthritis, is a condition that causes diffuse pain, stiffness, and limited range of motion in the shoulder joint. It occurs when the shoulder capsule, a flexible tissue that surrounds and encloses the shoulder joint, becomes thickened and inflamed. As a result, the capsule's inner lining produces excessive scar tissue, which leads to the formation of adhesions that restrict joint movement.

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Adhesive capsulitis typically develops gradually and progresses through different stages, with each stage lasting several months. There are four main stages:

1. Stage 1 (Pre-freezing Stage): Characterized by gradual onset of pain that increases with movement and is present at night. Loss of external rotation motion (outward rotation) with intact rotator cuff (a group of shoulder muscles and tendons that lift and move the arm away from the body) strength is common. The duration of this stage is usually less than 3 months.
2. Stage 2 (Freezing Stage): Characterized by persistent and more intense pain even at rest. The shoulder motion is limited in all directions. This stage is typically between 3 and 9 months. 
3. Stage 3 (Frozen Stage): In this stage, the pain is only present upon shoulder movement.  Muscle stiffness and limited range of motion persist, with substitute motions in the scapula (shoulder blade). The shoulder joint becomes noticeably stiff, making even simple movements challenging. This stage is between 9 and 15 months.
4. Stage 4 (Thawing Stage): The last stage of frozen shoulder is characterized by minimal pain with gradual improvement of the shoulder motion. This stage lasts from 15 to 24 months or longer. In some cases, patients never regain normal shoulder range of motion. 

Common symptoms of adhesive capsulitis

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Common symptoms of adhesive capsulitis, also known as frozen shoulder, include:

1. Shoulder Pain: Persistent and often severe pain in the shoulder joint is a hallmark symptom of adhesive capsulitis. The pain may be constant, and it can worsen during movements or activities that involve the shoulder. Night pain that leads to sleep disturbance is also present during acute flares.
2. Shoulder Stiffness: One of the primary characteristics of adhesive capsulitis is the progressive loss of shoulder mobility and range of motion. The shoulder may become noticeably stiff and difficult to move, making everyday tasks like reaching overhead, behind the back, or across the body challenging.
3. Limited Range of Motion: As the condition progresses, the range of motion in the shoulder joint becomes progressively restricted. Initially, external rotation (outward rotation) is often the most affected, but other movements, such as abduction (raising the arm to the side), flexion (over the head bending of shoulder) and internal rotation (inward rotation), may also be limited.
4. Gradual Onset: Adhesive capsulitis usually develops gradually over time. The symptoms may start mildly and worsen slowly, eventually becoming more pronounced.
5. Activity Limitations: Specific movements or activities that require extensive shoulder motion are limited, such as reaching overhead, behind the head, out to the side and behind the back; thus having difficulty in dressing, reaching hand into the back pocket of pants, self-grooming and other activities that may elicit significant pain.
6. Loss of Muscle Strength and Endurance: As shoulder mobility decreases, there may be a noticeable loss of muscle strength and endurance in the affected shoulder, making simple tasks more challenging.

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It's essential to note that these symptoms can vary in severity from person to person and can also change through the different stages of adhesive capsulitis (pre-freezing, freezing, frozen, and thawing stages). If you experience persistent shoulder pain, stiffness, or limited range of motion, it's important to seek medical attention for a proper evaluation and diagnosis. Early intervention and appropriate treatment can help manage symptoms and improve shoulder function.

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What causes adhesive capsulitis?

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The exact cause of adhesive capsulitis is not entirely understood, but certain factors may increase the risk of developing the condition, including:

• Age: Adhesive capsulitis is more common in people aged 40 to 60 years.
• Gender: Women are more likely to develop frozen shoulder than men.
• Diabetes: People with diabetes have a higher risk of developing adhesive capsulitis.
• Immobilization: Shoulder immobility due to injury, surgery, or other medical conditions can be a trigger.

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How can physical therapy help? 

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Physical therapy is an essential component of the treatment and management of adhesive capsulitis (frozen shoulder). A physical therapist can provide targeted interventions to reduce pain, improve shoulder mobility, and restore function. Here's how physical therapy can help with adhesive capsulitis:

1. Pain Management: Physical therapists may use various modalities such as heat, ice, ultrasound and electrical stimulation to help reduce pain and inflammation in the affected shoulder. In some cases, the shoulder may be immobilized in a sling to provide rest and minimize pain.
2. Passive Range of Motion Exercises: In the early stages of adhesive capsulitis when active movement is limited, physical therapists may perform gentle passive range of motion exercises to move the shoulder joint in all ranges of pain-free motion. 
3. Active Assisted and Active Range of Motion Exercises: As shoulder pain and stiffness improve, physical therapists may guide patients through an active range of motion with or without assistance to encourage more active movement of the shoulder joint.
4. Stretching Exercises: Gentle stretching exercises such as manual and self-stretching techniques are prescribed to improve flexibility and reduce stiffness in the shoulder and surrounding muscles.
5. Strengthening Exercises: Physical therapists design a customized strengthening program to target the muscles around the shoulder joint. Initially, low-load resistance is prescribed and as the joint tissue tolerates the intensity it progresses to a more challenging level. Strengthening these muscles can help stabilize the shoulder, improve muscle endurance and overall shoulder function.
6. Joint Mobilization: Manual therapy techniques like joint mobilization or manipulation can be used to increase joint mobility, improve shoulder joint mechanics and restore proper movement patterns.
7. Home Exercise Program: Physical therapists often provide patients with a home exercise program and teach them how to incorporate it into their daily routine to continue their exercises and maintain shoulder mobility between therapy sessions.
8. Education: Physical therapists educate patients about adhesive capsulitis, its stages and symptoms. They also teach  proper body mechanics, posture, and techniques to prevent re-injury and improve overall shoulder health.
9. Activity Modification: Physical therapists work with individuals to modify their daily activities or sports techniques to avoid movements that aggravate adhesive capsulitis and promote healing.

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It's essential to remember that the treatment plan for adhesive capsulitis will be tailored to the individual's specific needs and the stage of the condition. Consistency and compliance with the prescribed exercises and therapies are crucial to achieving positive outcomes with physical therapy for adhesive capsulitis. Early intervention and regular follow-up with a physical therapist can lead to faster recovery and improved shoulder function. If you experience persistent shoulder pain, stiffness, or limited range of motion, consult a healthcare professional for an accurate diagnosis and appropriate treatment plan.

Trust PeteHealth for treating adhesive capsulitis

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