Adhesive Capsulitis of the Shoulder (Frozen Shoulder)

Adhesive capsulitis, commonly known as frozen shoulder, is a condition that causes pain and stiffness in the shoulder joint. Because the shoulder is designed to move freely, prolonged limitation of movement can lead to significant stiffness and loss of function.

Frozen shoulder often develops after a shoulder injury causes pain and discourages normal use of the arm. A common underlying issue is a rotator cuff injury, which may range from mild rotator cuff tendinitis to a partial or complete tear. When pain limits shoulder movement, scar tissue can develop between the humeral head (the ball of the upper arm bone) and the glenoid (the shoulder socket). Over time, this loss of motion can lead to adhesive capsulitis.

In many cases, a frozen shoulder develops when an initial shoulder problem is treated by limiting movement for too long. While rest may be necessary after an injury, avoiding active movement of the arm can create a secondary problem: stiffness and scar tissue within the shoulder joint.

An orthopedic surgeon can evaluate your shoulder and measure your range of motion. One simple way to assess movement is to lie on your back with your elbows tucked at your sides, then rotate your forearms outward. Limited external rotation is a common sign of frozen shoulder. Internal rotation may also be restricted; for example, you may be unable to reach as high behind your back with the affected arm as you can with the opposite shoulder.

Another assessment involves stabilizing the scapula, or shoulder blade, while raising the arm. Normally, the shoulder should be able to elevate to a right angle without excessive movement of the shoulder blade. With frozen shoulder, people often compensate by moving the scapula rather than moving through the shoulder joint itself.

A diagnostic workup for frozen shoulder typically includes X-rays taken in the orthopedic surgeon's office, as well as an MRI to evaluate the rotator cuff and other internal shoulder structures. Patients may initially use a sling to manage inflammation or pain from a rotator cuff injury; however, prolonged immobilization can contribute to frozen shoulder. If the MRI reveals structural damage, such as a torn rotator cuff or torn labrum, surgical repair may be recommended.

Aggressive physical therapy is the primary treatment for frozen shoulder. Most patients require two to three months of therapy to improve motion. Reducing inflammation with an injection or medication may also help relieve pain and support progress in therapy.

If shoulder motion does not improve with conservative treatment, surgery may be the next step. The goal is to release the scar tissue and restore movement. This may be done under general anesthesia through manipulation of the shoulder, in which the shoulder is carefully moved through external rotation, internal rotation, and abduction to break up adhesions. Alternatively, the procedure can be performed arthroscopically using a small camera and specialized instruments to release scar tissue under direct visualization. Aggressive physical therapy is essential after surgery to help prevent scar tissue from reforming.