Adhesive capsulitis, often referred to as “frozen shoulder,” is a medical condition that affects the shoulder joint, causing pain, stiffness, and limited range of motion. It typically develops gradually over time and can be quite debilitating. The exact cause of adhesive capsulitis is not always clear, but it often occurs without any obvious injury or trauma. It is more common in people between the ages of 40 and 60 and is more prevalent in women than in men.

The condition involves inflammation and thickening of the capsule surrounding the shoulder joint. This capsule is a protective structure that contains the synovial fluid necessary for joint lubrication. When it becomes inflamed and thickened, it can lead to the characteristic symptoms of frozen shoulder, which include:

1. Pain: Initially, there may be aching pain in the shoulder that gradually worsens over time.
2. Stiffness: As the condition progresses, the shoulder joint becomes increasingly stiff, making it difficult to move the arm.
3. Limited Range of Motion: Range of motion in the affected shoulder becomes severely restricted, making daily activities and even simple tasks challenging.

Adhesive capsulitis involves four stages. 

1. Stage 1.  The first stage is when the capsule first becomes inflamed.  This stage typically only lasts for a few weeks but in uncommon cases this can be prolonged and last for many months.  During the first stage the shoulder is painful but is not stiff. 
2. Stage 2.  In stage 2 the capsule starts to thicken and shrink.  The hallmark of this stage is the shoulder starts to stiffen and lose motion.  During this stage the capsule is inflamed so pain is constant, but is worse on movement.  Untreated, during this phase the condition tends to worsen with increased pain and increased loss of motion over time.  Untreated, this phase typically lasts about 4-6 months.
3. Stage 3.  This is also referred to the thawing phase.  During this phase the inflammation has ended.  The capsule is thickened and stiff so pain occurs on motion but the constant pain from the inflammation has resolved.  During this phase motion slowly returns.
4. Stage 4.  This is the last phase.  Some people have continued loss of motion.  Diabetics tend to do worse with this condition and are more likely to have persistent loss of motion.

Treatment for adhesive capsulitis typically involves a combination of conservative approaches and, in some cases, medical interventions. Here are some common treatment options:

1. Physical Therapy: Physical therapy is often the primary treatment for adhesive capsulitis. A physical therapist can provide exercises and stretches to help improve range of motion and reduce pain. This can also be done as a home stretching program. They may also use techniques like manual therapy to mobilize the shoulder joint.
2. Pain Management: Over-the-counter pain relievers or prescription medications may be recommended to manage pain and inflammation.
3. Corticosteroid Injections: In some cases, a doctor may administer corticosteroid injections into the shoulder joint to reduce inflammation and pain.  This can change the course of the disease and push people from stage 1 or 2 to stage 3.  
4. Home Exercises: Patients are often prescribed daily exercises to perform at home to help maintain and improve shoulder mobility.  These should be done multiple times per day.
5. Joint Distension: In some cases, a doctor may use joint distension, where sterile water is injected into the joint capsule to stretch it and improve mobility.
6. Hydrodilatation: This is a procedure in which a doctor injects a combination of sterile water and corticosteroids into the joint capsule to stretch it and reduce inflammation.
7. Arthroscopic Capsular Release and Manipulation Under Anesthesia (MUA): In severe cases where other treatments are ineffective, a surgeon may perform an MUA procedure to forcefully manipulate the shoulder joint under anesthesia to break up adhesions as well as surgically release the thickened capsule in a minimally invasive procedure suing a camera to see into the joint.

It’s important to note that the recovery from adhesive capsulitis can be slow, and full resolution may take many months or even years. Therefore, early diagnosis and prompt initiation of treatment are essential for better outcomes. If you suspect you have frozen shoulder or are experiencing shoulder pain and stiffness, consult a healthcare professional at Total orthopedics and Sports Medicine for a proper evaluation and personalized treatment plan.