Adhesive capsulitis: what it is, symptoms, causes and treatment

Adhesive capsulitis, also known as ‘frozen shoulder’ is a situation where the person has an important limitation in shoulder movements, making it difficult to place the arm above shoulder height. This change can happen after prolonged periods of shoulder immobility. This condition affects only one shoulder and is more common in women. 

This disease can be found in different stages, which can be:

  • Freezing phase : shoulder pain gradually increases at rest, with the presence of acute pain in extreme limits of movement. This phase lasts 2-9 months;
  • Adhesive phase : the pain begins to subside, and appears only with movement, but the movements all movements are limited, with compensation with the scapula. This phase lasts 4-12 months.
  • Defrosting phase : characterized by progressive improvement in shoulder range of motion, absence of pain and synovitis, but with important capsule restrictions. This phase lasts 12-42 months.

In addition, the space between the glenoid and the humerus, as well as the space between the biceps and the humerus are greatly reduced, which prevents full shoulder movement. All these changes can be seen in an image exam, such as x-rays in different positions, ultrasound and shoulder atrography, requested by the doctor. 

Symptoms 

Symptoms include pain in the shoulder and difficulty raising the arms, with the feeling that the shoulder is stuck, ‘frozen’. 

The tests that can help to identify this disease are: X-ray, ultrasound and arthrography, which is the most important because it shows the reduction of synovial fluid within the joint and the reductions in the spaces within the joint itself. 

The diagnosis can take a few months to reach, because initially the person may have only pain in the shoulder and some limitation in movements, which can indicate a simple inflammation, for example. 

Causes

The cause of the frozen shoulder is not known, which makes its diagnosis and treatment options more difficult. It is believed that shoulder stiffness is due to a process of fibrous adhesions within the joint, which can happen after trauma to the shoulder or immobilization for a prolonged period. 

People who have a harder time dealing with the stress and pressure of everyday life have less tolerance for pain and are more likely to develop a frozen shoulder for emotional reasons. 

Other diseases that may be associated and appear to increase the chances of adhesive capsulitis are diabetes, thyroid disease, degenerative changes in the cervical spine, neurological diseases, due to the use of medications, such as phenobarbital to control seizures, tuberculosis and myocardial ischemia . 

Treatment 

Treatment is usually done using painkillers, anti-inflammatories and corticosteroids, in addition to physiotherapy sessions to increase shoulder movement, but there are cases where adhesive capsulitis has a spontaneous cure, with progressive improvement of symptoms, even without performing any type of treatment. specific treatment, and therefore there is not always a consensus on the best approach for each phase. 

Suprascapular nerve block with infiltration of local anesthetic and manipulation of the shoulder under general anesthesia may also be recommended.

Physiotherapy is always indicated and has good results, passive and active exercises are recommended, in addition to hot compresses that help to release movements little by little. Learn more about treatments for adhesive capsulitis here . 

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