Frozen Shoulder (Adhesive Capsulitis)
Michael Fu, MD
Frozen shoulder, also known as adhesive capsulitis, is a common shoulder condition that can be the cause of significant shoulder pain, stiffness, and dysfunction. The underlying cause of symptoms is inflammation, thickening, and tightening of the shoulder joint capsule. In a normal shoulder, the capsule is a thin, pliable layer of tissue that encapsulates the shoulder joint.
Shoulder joint capsule. Image courtesy of Visible Body.
In a shoulder with adhesive capsulitis, the joint capsule becomes thickened and inflamed. During arthroscopic surgery, the affected capsule can have this appearance:
Intra-operative appearance of inflamed and thickened capsule tissue in frozen shoulder (adhesive capsulitis).
Presenting symptoms
Frozen shoulder can occur spontaneously, or after any type of injury to the shoulder. Patients often report onset of frozen shoulder after even very minor shoulder injuries or strains, such as lifting something heavy or reaching in the backseat of their car. Frozen shoulder can also occur after shoulder surgery or any period of immobilization.
There are a number of demographic and medical factors that have been associated with the development of frozen shoulder. It more commonly occurs in women between the age of 40 to 60, often coinciding around the time of menopause, but it can happen to people of all ages and to men as well. It is also associated with endocrinological conditions such as diabetes and thyroid disorders.
Frozen shoulder is described as generally consisting of three phases - the freezing/inflammatory phase, the frozen/stiff phase, and finally the thawing phase. It is almost always a self-limiting disease, or in other words, frozen shoulder does get better on its own over time. However, this process of resolution can take a very long time - sometimes years!
Non-Surgical treatment
Non-surgical treatment is generally very successful at expediting the process of recovering from a frozen shoulder. The most important component of this is diligent supervised physical therapy with an emphasis on gentle, progressive shoulder stretching. The therapist can also add various modalities such as heat and cryotherapy to the stretching program. It is also important to have a daily home stretching regimen as well.
Managing shoulder inflammation and pain is also important to successful non-surgical treatment of frozen shoulder. This can be achieved through oral anti-inflammatory medications (i.e. ibuprofen, naproxen, meloxicam, etc.) or a cortisone injection. In addition to symptomatic relief, controlling the amount of inflammation in the shoulder can enable more effective physical therapy as well.
Surgical treatment for Frozen Shoulder (Capsular Release)
If non-surgical treatment is unsuccessful at restoring shoulder range of motion and function, then surgical treatment may be an option. The procedure would consist of shoulder arthroscopic capsular release, performed in a minimally-invasive fashion. Any other concurrent issues in the shoulder would be addressed at the time of surgery as well. During the surgery, the thickened contracted capsule around the shoulder joint is released, and a gentle manipulation under anesthesia is performed to restore full shoulder range of motion at the time of surgery.
Patients are advised to begin physical therapy as soon as possible after surgery, sometimes even the same day! The goal is to maintain the motion that was regained during surgery before any significant scar formation can occur. While most patients inevitably lose a bit of the full range of motion that was achieved in the operating room, they are generally still significantly improved compared to before surgery.
About the Author
Dr. Michael Fu is an orthopedic surgeon and shoulder specialist at the Hospital for Special Surgery (HSS) in New York City (NYC) and New Jersey (NJ), the best hospital for orthopedics as ranked by U.S. News & World Report. Dr. Fu is an expert at shoulder rotator cuff repair surgery, shoulder instability surgery, and shoulder replacement. Dr. Fu was educated at Columbia University and Yale School of Medicine, followed by orthopedic surgery residency at HSS and sports medicine & shoulder surgery fellowship at Rush University Medical Center in Chicago. He has been a team physician for the Chicago Bulls, Chicago White Sox, DePaul University, and NYC’s PSAL.
Disclaimer: All materials presented on this website are the opinions of Dr. Michael Fu and any guest writers, and should not be construed as medical advice. Each patient’s specific condition is different, and a comprehensive medical assessment requires a full medical history, physical exam, and review of diagnostic imaging. If you would like to seek the opinion of Dr. Michael Fu for your specific case, we recommend contacting our office to make an appointment.