From the Guidelines
Adhesive capsulitis, commonly known as frozen shoulder, is a condition characterized by stiffness and pain in the shoulder joint, often caused by inflammation and thickening of the capsule surrounding the joint, leading to restricted movement and adhesions. This condition is listed as one of the common causes of poststroke shoulder pain, along with traction/compression neuropathy, complex regional pain syndrome, shoulder trauma, bursitis/tendonitis, rotator cuff tear, and heterotrophic ossification 1. The treatment of shoulder pain, including adhesive capsulitis, typically involves a combination of interventions such as electrical stimulation, treatment with steroid injections/medication, exercise, shoulder positioning protocols, strapping the involved upper extremity, and modalities including ice, heat, soft tissue massage, and mobilization 1.
Some key points to consider in the management of adhesive capsulitis include:
- The use of intra-articular injections, such as triamcinolone, which have been found to have significant effects on pain and improvement in range of motion (ROM) 1, 2
- The importance of exercise and physical therapy, including gentle stretching exercises, to improve ROM and prevent further complications such as frozen shoulder and shoulder-hand pain syndrome 2
- The consideration of interventions to prevent shoulder pain, such as electrical stimulation, shoulder strapping, and staff education to prevent trauma to the hemiplegic shoulder 2
The most effective treatment approach for adhesive capsulitis should prioritize a combination of pain management, physical therapy, and prevention of further complications, with a focus on improving ROM and reducing pain and stiffness. This may involve a structured physical therapy program, including exercises such as pendulum stretches, wall crawls, and cross-body reaches, as well as the use of modalities such as ice, heat, and soft tissue massage 1, 2.
From the Research
Definition and Characteristics 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 3.
- It is predominantly an idiopathic condition and has an increased prevalence in patients with diabetes mellitus and hypothyroidism 3.
- The condition progresses in three stages: freezing (painful), frozen (adhesive), and thawing, and is often self-limiting 4.
Clinical Presentation and Diagnosis
- Adhesive capsulitis is characterized by disabling pain and restricted movements 5.
- Although imaging is not necessary to make the diagnosis, a finding of coracohumeral ligament thickening on noncontrast magnetic resonance imaging yields high specificity for adhesive capsulitis 3.
- The diagnosis is often made based on clinical presentation and medical history.
Treatment Options
- Nonsurgical treatments include nonsteroidal anti-inflammatory drugs, short-term oral corticosteroids, intra-articular corticosteroid injections, physiotherapy, acupuncture, and hydrodilatation 3.
- Physiotherapy and corticosteroid injections combined may provide greater improvement than physiotherapy alone 3.
- Surgical treatment options for patients who have minimal improvement after six to 12 weeks of nonsurgical treatment include manipulation under anesthesia and arthroscopic capsule release 3, 6.
- Arthroscopic capsular release is a suitable option for patients with refractory primary frozen shoulder syndrome, leading to a faster and long-lasting recovery 6.