Adhesive Capsulitis

I have had the pleasure of caring for a number of individual   following shoulder surgery over this past year so I am sharing one of the complications that may occur following this type of surgery.  Adhesive capsulitis is the medical term used to describe a substantial range of motion loss in the shoulder.  Sometimes this is referred to as a “frozen shoulder”.  This condition is painful as the shoulder capsule becomes contracted and thickened.  Pain will increase as a person or their physician tries moves the shoulder or tries to passively put the shoulder through the range of motion.

Many of my patient’s hear me say, “I hate shoulders” or after shoulder surgery, “No pain, no gain”.  My experience is that I see “frozen shoulders” after shoulder surgery.  The exact cause of this condition is not well described in the literature and it is not found to be the result of a rotator cuff tear. 

There are however, risk factors associated with this phenomenon.  Individuals with diabetes are more prone to adhesive capsulitis as are women between the ages of 30 and 50.  There may be other underlying diseases such as thyroid disease, Parkinson’s disease or cardiac disease.  This condition is often noted following shoulder surgery following a period of immobilization.

The patient will note a dull, achy pain that increases with motion and/or activity.  The pain is often located in the shoulder itself, but sometimes can occur in the upper arm below the shoulder.  The shoulder’s motion is restricted due to stiffness.

The initial treatment is pain control and physical therapy to restore the shoulder’s motion.  Literature notes that about 95% of those affected with note some improvement or resolution within 2 years.  Aggressive physical therapy is utilized over the first year.  Local nerve blocks may be used to decrease the pain while physical therapy is being utilized. 

If conservative therapy fails, the physician may recommend manipulation under anesthesia or shoulder arthroscopy.  During manipulation under anesthesia, the patient is put to sleep and the surgeon manipulates the shoulder to move forcing the capsule to tear and/or stretch.  The shoulder arthroscopy usually involves a release of the shoulder with small incisions to free the capsule allowing for movement in the area.  Both procedures are followed by intense (usually daily) physical therapy with emphasis on range of motion within the joint.

In summary, physical therapy is sometimes painful, especially when involving the shoulder joint.  I encourage my patient’s to give therapy their very best effort to ensure decreased pain and a return to normal function and range of motion.  It is helpful to take your prescribed pain medication prior to the therapy sessions (at least initially).  Icing of the shoulder joint following therapy also helps to control the pain.  Ask your therapist for instructions on a home exercise program that can be done at home to increase.  Most of all, stay strong as most people regain functional range of motion over time.