Frozen shoulder

Adhesive capsulitis, or frozen shoulder, is a painful condition which results in a severe loss of motion in the shoulder. It may follow an injury to the shoulder, but may also arise gradually with no warning or injury.

The shoulder actually "freezes up" due to the severe inflammation of the joint capsule. The loose tissue of the joint capsule that usually allows a great deal of motion at the shoulder sticks together, limiting the motion. Why this should occur all of a sudden is still a mystery.

Adhesive capsulitis may begin following other injuries when the shoulder is not moved around normally because of the other injury. A common example is after a wrist fracture, where the arm may be kept in a sling for several weeks. For some reason, this seems to start the process in some people. The condition has also been known to occur after surgical procedures for something unrelated to the shoulder, and even after recovering from a heart attack.

The condition can begin while other shoulder problems are present. Sometimes problems such as bursitis, impingement syndrome, or a partial rotator cuff tear can lead to a frozen shoulder. The pain from the first condition may cause you to decrease the use of the shoulder, and the underlying condition itself may lead to chronic inflammation. These two things combine to make a dangerous situation that may result in the development of adhesive capsulitis . Usually, the adhesive capsulitis must be treated first to regain motion in the shoulder before the underlying problem can be addressed.

The symptoms are primarily pain and a reduced range of motion in the joint. The range of motion is the same whether you are trying to move the shoulder under your own power or someone else is trying to raise the arm for you. There comes a point in each direction of movement where the motion simply stops as if there is something blocking the movement. The shoulder usually hurts when movement reaches the limit of the range of motion, and can be quite painful at night.

The diagnosis of adhesive capsulitis is usually made based on history and physical examination. One key finding that can help differentiate adhesive capsulitis from a rotator cuff tear is how the shoulder moves. In adhesive capsulitis the shoulder motion is the same, whether the patient or the osteopath tries to move the arm. In a rotator cuff tear, the patient cannot move the arm, but when someone else lifts the arm it can be moved in a nearly normal range of motion. Xrays are usually not helpful. An MRI may show that the shoulder capsule is scarred and contracted. An MRI scan is a special radiological test where magnetic waves are used to create pictures that look like slices of the shoulder. The MRI scan shows more than the bones of the shoulder. It can show the tendons as well, and whether there has been a tear in those tendons.

Treatment of the frozen shoulder can be frustrating and slow. Most cases will improve more quickly with regular osteopathic treatment. Depending on the stage of development of the condition, you can expect it to take between 4 to 13 treatments to resolve. Some cases of trauma can make the treatment longer.