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SHOULDER

Adhesive Capsulitis (Frozen Shoulder)

 

Adhesive capsulitis, also known as “Frozen Shoulder”, is a condition that causes pain, stiffness and eventual loss of range of motion in the shoulder. Secondary to pain, our natural response is to use the shoulder less and less to avoid discomfort. Over time, due to this lack of motion/ change in shoulder mechanics, as well as biological inflammatory properties, the shoulder becomes very hard to move and can cause limitations in daily activities, such as washing and brushing hair, brushing teeth, dressing, cooking, doing yardwork, etc.

Anatomy:
Your shoulder anatomy is referred to as a “ball and socket joint” and is made up of the upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle). The “ball” or head of the humerus and the “socket”, or part of the scapula, are surrounded by a capsule with fluid (synovial fluid) that lubricates the joint and encourages ease of motion.

In adhesive capsulitis, the shoulder joint capsule becomes inflamed, thickens, and forms fibers that lock down the joint called adhesions causing stiffness. Often times, this is accompanied by less fluid in the shoulder joint. Less fluid/lubrication and decreased motion creates the hallmark sign of frozen shoulder: decreased ability to freely and fully move the shoulder on your own or with help, and pain.

Causes:
The causes of frozen shoulder are widely unknown and thought to be multifactorial, however history of diabetes, past surgical history of the shoulder, previous injury or immobilization of the joint for extended periods of time and other diseases have been shown to be contributing factors. It is typically more common in the age group of 40-60 years old and is more common in women than men.

Treatment:
Non-surgical interventions include:
• Non-steroidal anti-inflammatory medications: ex) ibuprofen (Advil), Naprosyn (Aleve) can reduce pain and inflammation.
• Corticosteroid injections: steroids are powerful anti-inflammatory medications which can be injected directly into your shoulder joint (glenohumeral joint), and/or in the space that exists above your rotator cuff tendons (the subacromial space) in order to help break up scar tissue (adhesions) and decrease inflammation, two of the causes of adhesive capsulitis
• Physical Therapy/ Home Exercises: Stretches and exercises are vital to correct shoulder mechanics by increasing range of motion, and eventually strengthening the shoulder
Surgical interventions include:
• Closed manipulation: a procedure during which the shoulder is manipulated under anesthesia, in order to stretch the joint capsule and break up adhesions
• Capsular release: an arthroscopic procedure under general anesthesia which includes releasing the tight capsule of the shoulder joint to allow increased range of motion
• These two procedures can be used in conjunction to treat adhesive capsulitis if non-surgical management is not working to increase range of motion
If you think that you may have adhesive capsulitis or frozen shoulder, it is important to be properly examined in order to begin treatment and rule out other causes of shoulder pain/decreased range of motion.

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