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ADHESIVE CAPSULITIS / FROZEN SHOULDER
Adhesive Capsulitis, or a Frozen Shoulder, is a poorly understood condition in which the deepest layers of soft tissue, called the joint capsule, become diseased.
Shoulder range of motion becomes very limited and painful.
The cause of a frozen shoulder is still not known but minor traumas, hyperthyroidism, diabetes, psychiatric patients, post-surgical patients, and prolonged immobilization of the shoulder may in someway cause this condition.
The disease is characterized as having freezing, frozen, and thawing stages, and is self-limiting (in time it goes away on its own). However, it can take two years or more to recover from this condition.
Physical therapy consisting of patient education, stretching, joint mobilization, and a home exercise program can help speed recovery. For a small percentage of frozen shoulder patients, it may take two years or more to recover.
What part of the shoulder is affected?
The shoulder is made up of three bones: the scapula (shoulder blade), the humerus (upper arm bone), and the clavicle (collarbone).
The joint capsule is a watertight sac that encloses the joint and the fluids that bathe and lubricate it.
The walls of the joint capsule are made up of ligaments. Ligaments are soft connective tissues that attach bones to bones.
The joint capsule has a considerable amount of slack, loose tissue, so the shoulder is unrestricted as it moves through its large range of motion.
In frozen shoulder, inflammation in the joint makes the normally loose parts of the joint capsule stick together. This seriously limits the shoulder's ability to move, and causes the shoulder to freeze.
SymptomsWhat are the symptoms of frozen shoulder?
The symptoms of frozen shoulder are primarily shoulder pain and a very reduced range of motion in the joint.
The range of motion is the same whether you are trying to move the shoulder yourself or someone else is trying to move the arm for you.
There comes a point in each direction of movement where the motion simply stops, as if something is blocking it.
At this point, the shoulder usually hurts.
The shoulder can also be quite painful at night.
The tightness in the shoulder can make it difficult to do regular activities like getting dressed, combing your hair, or reaching across a table.
DiagnosisWhat tests will my doctor run?
The diagnosis of frozen shoulder is usually made on the basis of your medical history and physical examination.
One key finding that helps differentiate a frozen shoulder from a rotator cuff tear is how the shoulder moves.
With frozen shoulder, the shoulder motion is the same whether the patient or the doctor tries to move the arm.
With 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.
Simple X-rays are usually not helpful.
An arthrogram may show that the shoulder capsule is scarred and tightened.
The arthrogram involves injecting dye into the shoulder joint and taking several X-rays.
In frozen shoulder, very little dye can be injected into the shoulder joint because the joint capsule is stuck together, making it smaller than normal.
The X-rays taken after injecting the dye will show very little dye in the joint.
TreatmentWhat treatment options are available?
Nonsurgical TreatmentTreatment of frozen shoulder can be frustrating and slow. Most cases eventually improve, but the process may take months.
The goal of your initial treatment is to decrease inflammation and increase the range of motion of the shoulder. Y
our doctor will probably recommend anti-inflammatory medications, such as aspirin and ibuprofen.
Physical or occupational therapy treatments are a critical part of helping you regain the motion and function of your shoulder.
Treatments are directed at getting the muscles to relax.
Therapists use heat and hands-on treatments to stretch the joint capsule and muscle tissues of the shoulder.
You will also be given exercises and stretches to do as part of a home program.
You may need therapy treatments for three to four months before you get full shoulder motion and function back.
Your doctor may also recommend an injection of cortisone and a long-acting anesthetic, similar to lidocaine, to get the inflammation under control. Cortisone is a steroid that is very effective at reducing inflammation.
Controlling the inflammation relieves some pain and allows the stretching program to be more effective. In some cases, it helps to inject a long-acting anesthetic with the cortisone right before a stretching session.
This allows your therapist to manually break up the adhesions while the shoulder is numb from the anesthetic.
RehabilitationWhat can I expect after treatment?
Nonsurgical RehabilitationThe primary goal of physical therapy is to help you regain full range of motion in the shoulder.
If your pain is too strong at first to begin working on shoulder movement, your therapist may need to start with treatments to help control pain.
Treatments to ease pain include ice, heat, and electrical stimulation.
Therapists also use massage or other types of hands-on treatment to ease muscle spasm and pain.
When your shoulder is ready, therapy will focus on regaining your shoulder's movement.
Sessions may begin with treatments like moist hot packs or gentle warm-up exercises.
These treatments relax the muscles and get the shoulder tissues ready to be stretched.
Therapists then begin working to loosen up the shoulder joint, especially the joint capsule.
You can also get a good stretch using an overhead shoulder pulley in the clinic or as part of a home program.
If your doctor recommends an injection for your shoulder, you should plan on seeing your therapist right after the injection.
The extra fluid from the injection stretches out the tissues of the joint capsule.
An aggressive session of stretching right afterward can help maximize the stretch to the joint capsule.
After SurgeryAfter arthroscopic release, you'll likely begin using a shoulder pulley on a daily basis.
You'll probably be encouraged to use the treated arm in everyday activities.
Strengthening exercises are not begun for four to six weeks after the procedure.
You might participate in physical or occupational therapy for up to two months after arthroscopic release.
You'll resume therapy within one to two days of the shoulder manipulation.
Some surgeons have their patients in therapy every day for one to two weeks.
Your therapist will treat you with aggressive stretching to help maximize the benefits of the shoulder manipulation.
The stretching also keeps scar tissue from forming and binding the capsule again.
Your shoulder movement should improve continually after the manipulation and therapy. If not, you may require more than one manipulation.
Once your shoulder is moving better, treatment is directed toward shoulder strengthening and function.
These exercises focus on the rotator cuff and shoulder blade muscles.
Your therapist will help you retrain these muscles to help keep the ball of the humerus centered in the socket. This lets your shoulder move smoothly during all your activities.
The therapist's goal is to help you regain shoulder motion, strength, and function.
When you are well under way, regular visits to the therapist's office will end.
Your therapist will continue to be a resource, but you will be in charge of doing your exercises as part of an ongoing home program.
Shoulder range of motion becomes very limited and painful.
The cause of a frozen shoulder is still not known but minor traumas, hyperthyroidism, diabetes, psychiatric patients, post-surgical patients, and prolonged immobilization of the shoulder may in someway cause this condition.
The disease is characterized as having freezing, frozen, and thawing stages, and is self-limiting (in time it goes away on its own). However, it can take two years or more to recover from this condition.
Physical therapy consisting of patient education, stretching, joint mobilization, and a home exercise program can help speed recovery. For a small percentage of frozen shoulder patients, it may take two years or more to recover.
What part of the shoulder is affected?
The shoulder is made up of three bones: the scapula (shoulder blade), the humerus (upper arm bone), and the clavicle (collarbone).
The joint capsule is a watertight sac that encloses the joint and the fluids that bathe and lubricate it.
The walls of the joint capsule are made up of ligaments. Ligaments are soft connective tissues that attach bones to bones.
The joint capsule has a considerable amount of slack, loose tissue, so the shoulder is unrestricted as it moves through its large range of motion.
In frozen shoulder, inflammation in the joint makes the normally loose parts of the joint capsule stick together. This seriously limits the shoulder's ability to move, and causes the shoulder to freeze.
SymptomsWhat are the symptoms of frozen shoulder?
The symptoms of frozen shoulder are primarily shoulder pain and a very reduced range of motion in the joint.
The range of motion is the same whether you are trying to move the shoulder yourself or someone else is trying to move the arm for you.
There comes a point in each direction of movement where the motion simply stops, as if something is blocking it.
At this point, the shoulder usually hurts.
The shoulder can also be quite painful at night.
The tightness in the shoulder can make it difficult to do regular activities like getting dressed, combing your hair, or reaching across a table.
DiagnosisWhat tests will my doctor run?
The diagnosis of frozen shoulder is usually made on the basis of your medical history and physical examination.
One key finding that helps differentiate a frozen shoulder from a rotator cuff tear is how the shoulder moves.
With frozen shoulder, the shoulder motion is the same whether the patient or the doctor tries to move the arm.
With 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.
Simple X-rays are usually not helpful.
An arthrogram may show that the shoulder capsule is scarred and tightened.
The arthrogram involves injecting dye into the shoulder joint and taking several X-rays.
In frozen shoulder, very little dye can be injected into the shoulder joint because the joint capsule is stuck together, making it smaller than normal.
The X-rays taken after injecting the dye will show very little dye in the joint.
TreatmentWhat treatment options are available?
Nonsurgical TreatmentTreatment of frozen shoulder can be frustrating and slow. Most cases eventually improve, but the process may take months.
The goal of your initial treatment is to decrease inflammation and increase the range of motion of the shoulder. Y
our doctor will probably recommend anti-inflammatory medications, such as aspirin and ibuprofen.
Physical or occupational therapy treatments are a critical part of helping you regain the motion and function of your shoulder.
Treatments are directed at getting the muscles to relax.
Therapists use heat and hands-on treatments to stretch the joint capsule and muscle tissues of the shoulder.
You will also be given exercises and stretches to do as part of a home program.
You may need therapy treatments for three to four months before you get full shoulder motion and function back.
Your doctor may also recommend an injection of cortisone and a long-acting anesthetic, similar to lidocaine, to get the inflammation under control. Cortisone is a steroid that is very effective at reducing inflammation.
Controlling the inflammation relieves some pain and allows the stretching program to be more effective. In some cases, it helps to inject a long-acting anesthetic with the cortisone right before a stretching session.
This allows your therapist to manually break up the adhesions while the shoulder is numb from the anesthetic.
RehabilitationWhat can I expect after treatment?
Nonsurgical RehabilitationThe primary goal of physical therapy is to help you regain full range of motion in the shoulder.
If your pain is too strong at first to begin working on shoulder movement, your therapist may need to start with treatments to help control pain.
Treatments to ease pain include ice, heat, and electrical stimulation.
Therapists also use massage or other types of hands-on treatment to ease muscle spasm and pain.
When your shoulder is ready, therapy will focus on regaining your shoulder's movement.
Sessions may begin with treatments like moist hot packs or gentle warm-up exercises.
These treatments relax the muscles and get the shoulder tissues ready to be stretched.
Therapists then begin working to loosen up the shoulder joint, especially the joint capsule.
You can also get a good stretch using an overhead shoulder pulley in the clinic or as part of a home program.
If your doctor recommends an injection for your shoulder, you should plan on seeing your therapist right after the injection.
The extra fluid from the injection stretches out the tissues of the joint capsule.
An aggressive session of stretching right afterward can help maximize the stretch to the joint capsule.
After SurgeryAfter arthroscopic release, you'll likely begin using a shoulder pulley on a daily basis.
You'll probably be encouraged to use the treated arm in everyday activities.
Strengthening exercises are not begun for four to six weeks after the procedure.
You might participate in physical or occupational therapy for up to two months after arthroscopic release.
You'll resume therapy within one to two days of the shoulder manipulation.
Some surgeons have their patients in therapy every day for one to two weeks.
Your therapist will treat you with aggressive stretching to help maximize the benefits of the shoulder manipulation.
The stretching also keeps scar tissue from forming and binding the capsule again.
Your shoulder movement should improve continually after the manipulation and therapy. If not, you may require more than one manipulation.
Once your shoulder is moving better, treatment is directed toward shoulder strengthening and function.
These exercises focus on the rotator cuff and shoulder blade muscles.
Your therapist will help you retrain these muscles to help keep the ball of the humerus centered in the socket. This lets your shoulder move smoothly during all your activities.
The therapist's goal is to help you regain shoulder motion, strength, and function.
When you are well under way, regular visits to the therapist's office will end.
Your therapist will continue to be a resource, but you will be in charge of doing your exercises as part of an ongoing home program.