Diagnosis

FROZEN SHOULDER

(ADHESIVE CAPSULITIS)


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 Definition A frozen shoulder is defined as a loss of both active (movement without assistance) and passive (movement with assistance) motion.
Details A frozen shoulder is medically known as adhesive capsulitis. The motion loss in this disorder is due to tightening and thickening of the ligaments and other supporting structures of the shoulder. This tightening and thickening (fibrosis) results in restriction of movement that can severely limit function.

Most cases of frozen shoulder follow a specific pattern. Initially, there is an acute phase that is characterized by significant pain, difficulty sleeping and significant functional impairment. This is followed by a progressive stiffening phase when the shoulder motion worsens. The final phase is the resolution or thawing phase identified by the gradual return of both motion and function. The overall course is variable but can last 12-24 months.
Causes A frozen shoulder may arise after a fracture or other arm injury. It may also be related to a rototor cuff tear, degenerative arthritis or previous shoulder surgery. Many cases of frozen shoulder, however, do not have a known cause. These cases are called idiopathic or primary adhesive capsulitis. Despite not having a known cause, primary adhsive capsulitis can be associated with systemic disorders such as diabetes and cardiovasular disease.
Diagnosis If there is loss of both active (movement without assistance) and passive (movement with assistance) on physical examination, the diagnosis of a frozen shoulder can be made. The patient will also describe a pattern of pain that is a times severe and at other times mild. The overall function of the shoulder in the acute phase of a frozen shoulder is poor.

Xrays are taken to rule out other shoulder disorders such as degenerative arthritis. Magnetic resonance imaging (MRI) may also occasionally be used to further evaluate the shoulder.
Treatment Nonoperative: Anti-inflammatory medications, stretching and physical therapy are the primary non-operative treatments. The physical therapy should be supplemented with a home or internet based program. Cortisone injections may also play a role in the nonoperative treatment of this disorder.

Operative: If nonoperative measures fail, manipulation (passive movement of the arm to break up contracted shoulder tissues) under anesthesia may be required. Arthroscopy of the shoulder may also be indicated in some cases to surgically release some tight stuctures.

Frozen shoulders must be treated on an individual basis because there is significant variability in the clinical response to treatment. The details of any treatment are best discussed with your health care provider.
Prevention

Maintaining a strong and flexible shoulder may prevent some cases of frozen shoulder.


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