Adhesive capsulitis or “Frozen Shoulder” as it is more commonly known by, is a condition in which the shoulder lining or capsule becomes really inflamed or irritated. This can occur spontaneously or after an injury or surgery in which the arm is left immobile for a period of time. People who have diabetes or thyroid disease are at a far higher risk of developing adhesive capsulitis than people who do not have these conditions. The reason for this is still not known, but frozen shoulder affects 10-20% of people with diabetes according to the American Academy of Orthopaedic Surgeons. Women are also more likely than men to develop frozen shoulder, and it most commonly affects those between the ages of 40-60.
Frozen shoulder occurs in three distinct stages: the “freezing” stage, the “frozen” stage, and the “thawing” stage. (Clever names for the stages right?!). During the freezing stage, there is onset of pain with every range of motion, especially at the extremes. As the pain increases, the motion decreases. The first signs of decreased motion are those of external rotation, and internal rotation. External rotation is something we do when we try to put a shirt or coat on. Internal rotation is commonly done when we are trying to put a belt on. The frozen stage is when the shoulder is completely locked up and there is little to no motion and immense pain with trying to do any motion. The thawing stage is when motion starts to increase and pain decreases. When all is said and done, this whole process can take anywhere from 12-18 months to go away on its own with no treatment, but who has that long to wait?!
The name of the game when it comes to treating frozen shoulder is motion, motion, motion, and calming down inflammation that is causing pain. Usually we start by doing a steroid injection to calm down the inflammation of the shoulder lining. The injection delivers medicine right at the scene of the crime which decreases pain and allows for better motion. We also recommend aggressive physical therapy for about 4 weeks with a therapist so they can really push you to break up these adhesions (scar tissue) that have formed inside the shoulder. We will also usually add a potent anti-inflammatory medication by mouth as well, usually something like Toradol or a Medrol dose pack (steroid). Usually this regimen will cure frozen shoulder and no surgical treatment is needed. But if after 3-4 weeks of giving this a good ol’ college try with no success, then it’s time to talk about surgical intervention.
Surgical intervention usually includes what’s called a manipulation under anesthesia (MUA) which is sometimes accompanied by a lysis of adhesions (LOA). A MUA is when we put you to sleep with anesthesia and move your shoulder for you, breaking up those adhesions. If you are one of the people who have diabetes or thyroid disease, then we are more apt to also add a LOA, which is where we do an arthroscopy with it. During the arthroscopy we make two little poke holes and finish removing any adhesions not broken up by the MUA. As I mentioned earlier, people with diabetes and thyroid disease are more likely for this condition, so we take a little extra measure to insure they get their motion back.
That is adhesive capsulitis or frozen shoulder in a nutshell. It most commonly occurs after a period of immobilization or a specific injury to the shoulder, but it is very common to just happen spontaneously as well, especially in people with diabetes or thyroid disease. Most of the time it can be treated non-operatively, but sometimes surgical intervention is needed. Frozen shoulder is something I see and treat on a consistent basis, so if you or someone you know is experiencing any of the these symptoms come see me at McLean County Orthopedics, and I will help get you back in the game!