Frozen Shoulder/Adhesive Capsulitis

What is it?

Adhesive Capsulitis, commonly known as Frozen Shoulder, is a condition that affects the gleno-humeral joint which consists of the humeral head and the glenoid.  The humeral head is two to four times that of the glenoid, and the diameter of the humeral head is nearly twice that of the glenoid when measured in the transverse plain.  This lack of particular contact contributes to the inherent instability of the gleno-humeral joint.  Stability of the joint is provided by the surrounding musculature, by the fibro-cartilaginous labrum which creates a more conforming surface to the glenoid by the shoulder capsule.  Adhesive Capsulitis occurs when there are pathologic changes to this structure, including fibrosis and thickening of the gleno-humeral capsule.

Symptoms

Symptoms include aching pain in the outer part of the shoulder, limited range of motion, and stiffness.

What causes it?

Adhesive Capsulitis has been classified into primary (idiopathic) and secondary types.  Primary cases occur spontaneously.  Secondary cases commonly develop in response to trauma to the upper extremity, upper extremity immobilisation (such as after surgery or after an injury), and abnormal shoulder mechanics.

Who does it affect?

It typically occurs between 40-60 years of age.  Women are more likely to be affected by it than men.  It occurs more often in the left shoulder.  While the definitive aetiology of this condition is unknown, Adhesive Capsulitis has been reported to have associations with other conditions including; cervical spine disease, diabetes mellitus, rheumatoid arthritis, infections myocardial infarction, and pulmonary cancer.  It has also been reported to have associations with cervical pain (25%), calcium deposits (10%), and diabetes (6%).

Treatment

There are numerous options available:

• Steroid injection
• Surgical capsular release
• Conservative treatment such as chiropractic that consists of specific muscle release techniques to the rotator cuff muscles.
• Or do nothing

Prognosis

The condition is painful, however it can be self-limiting (it will resolve on its own whether or not any interventions or medications are used), with the average duration of symptoms being 2.5 years, with external rotation decreasing.