Adhesive Capsulitis

Adhesive capsulitis is a painful condition of the shoulder in which people develop restricted active and passive shoulder motion in all planes.  This is due to a thickened, and contracted joint capsule. The reason this happens is generally unknown. It may be related to immunologic, inflammatory, biochemical, or endocrine abnormalities. Adhesive capsulitis has been associated with diabetes, cervical spondylosis, and hypothyroidism.

Adhesive capsulitis generally occurs in late middle age (average age is 56). It causes progressive pain and stiffness and generally has a spontaneous onset. It causes decreased range of motion in all planes. Without any treatment, pain and motion generally improve in 1-3 years. Most people will have some residual loss of motion over many years, but will not have any functional limitations.

Treatment options include supervised neglect, steroid injections, physical therapy, manipulation under anesthesia, arthroscopic release, and open release.

Supervised neglect includes an explanation of the natural course of the disease, instructions not to exercise in excess of pain threshold, and instructions to do pendulum exercises and active exercises within a painless range and to resume all activities as tolerated. People with adhesive capsulitis treated with supervised neglect have shown 89% near normal shoulder function at 24 months, and 64% near normal shoulder function at 12 months. 

Corticosteroid injections can improve symptoms, especially if done early in the course of disease. Physical therapy may decrease the length of time of shoulder stiffness.

People with adhesive capsulitis who fail to improve with conservative measures or who have adhesive capsulitis due to postsurgical or post traumatic causes may require surgery. Surgical options include manipulation under anesthesia, arthroscopic capsular release and open capsular release.

Potential complications of arthroscopic capsular release include but are not limited to: Recurrent pain and stiffness, Proximal humerus fracture, Instability, Stiffness / Arthrofibrosis, Chondral Injury / Arthritis, Infection, rotator cuff tear, NVI (Axillary nerve palsy), Fluid Extravasation / Compartment Syndrome, Complex Regional Pain Syndrome, Synovial fistula, Hemarthrosis / hematoma, DVT / PE and the risk of anesthesia including heart attack, stroke and death. Complications are uncommon and the most patients are satisfied with the results of surgery.

Following surgery people generally use a sling for comfort and begin aggressive range of motion exercises with physical therapy immediately. Physical therapy after surgery is as much as important to your final outcome as the surgery is itself. Patients follow-up with there surgeon 10-14 days after surgery. Physical therapy and a home exercise program focused on range of motion are continued for several months after surgery. A persons return to full activity and sports is very dependent on their progress with physical therapy and the underlying cause and amount of stiffness prior to surgery.

Further information about Adhesive capsulitis can be found at the following sites:

Every person and their particular circumstances are different so the treatment for your shoulder may be different than those discussed. Please read this information carefully. Write down any questions that you have about your shoulder and its treatment and discuss them with your orthopaedic surgeon.

Frozen Shoulder, Adhesive Capsulitis

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