From the Guidelines
Adhesive capsulitis, or frozen shoulder, can be acquired through prolonged immobilization, such as after surgery or injury, and is also associated with various risk factors including diabetes, thyroid disorders, and cardiovascular disease. The exact cause of adhesive capsulitis remains unclear, but it is often linked to conditions that affect the shoulder joint and surrounding tissues. Some of the key risk factors for developing adhesive capsulitis include:
- Diabetes, which increases the risk 2-4 times
- Thyroid disorders
- Cardiovascular disease
- Parkinson's disease
- Being female, particularly between ages 40-60
In terms of treatment, a stepwise approach is typically recommended, starting with pain management using NSAIDs like ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) 1. Physical therapy is also crucial, focusing on gentle stretching exercises performed daily to maintain and improve range of motion. According to the Canadian Stroke Best Practice Recommendations, gentle stretching and mobilization techniques can help increase external rotation and abduction, and active range of motion should be increased gradually in conjunction with restoring alignment and strengthening weak muscles in the shoulder girdle 1.
Corticosteroid injections, such as triamcinolone 40mg or methylprednisolone 40-80mg, into the glenohumeral joint can provide significant pain relief during the painful freezing phase. For persistent cases, more invasive options include hydrodilatation (capsular distension with saline injection), manipulation under anesthesia, or arthroscopic capsular release. Most cases resolve within 1-3 years even without treatment, but appropriate intervention can significantly reduce this timeline and improve quality of life. Heat application before exercises and ice after can help manage discomfort during the rehabilitation process. It's also important to note that preventing shoulder pain in the involved upper extremity after a stroke can be achieved through interventions such as electrical stimulation, shoulder strapping, and staff education to prevent trauma to the hemiplegic shoulder 1.
From the Research
Causes and Risk Factors of Adhesive Capsulitis
- Adhesive capsulitis, also known as "frozen shoulder," is a common shoulder condition characterized by pain and decreased range of motion, especially in external rotation 2.
- The condition is predominantly idiopathic, but it has an increased prevalence in patients with diabetes mellitus and hypothyroidism 2, 3, 4.
- Diabetes mellitus is a significant risk factor, with patients with diabetes being 5 times more likely to have adhesive capsulitis than controls 5.
- The overall prevalence of adhesive capsulitis in patients with diabetes mellitus is estimated at 13.4% 5.
- Thyroid dysfunction is also a risk factor for adhesive capsulitis 2, 3.
Treatment Options for Adhesive Capsulitis
- Nonsurgical treatments are the mainstay of treatment, including nonsteroidal anti-inflammatory drugs, short-term oral corticosteroids, intra-articular corticosteroid injections, physiotherapy, acupuncture, and hydrodilatation 2, 3, 4.
- Physiotherapy and corticosteroid injections combined may provide greater improvement than physiotherapy alone 2.
- Surgical treatment options, such as manipulation under anesthesia and arthroscopic capsule release, are considered for patients who have minimal improvement after six to 12 weeks of nonsurgical treatment 2, 4.
- Recent studies underscore the importance of early intervention and individualized treatment plans tailored to the patient's needs 4.
- Techniques such as the suprascapular nerve block have gained prominence for their effectiveness in reducing pain and facilitating rehabilitation 4.