Adhesive capsulitis, commonly known as frozen shoulder, is a common cause of shoulder pain and loss of motion less commonly seen in athletes compared to the overall population. It can either be a primary problem, where there is no underlying structural damage causing the loss of motion, or it can be secondary to an injury such as a rotator cuff tear.
Signs and symptoms of frozen shoulder
Typically patients will complain of pain with activity that comes on over time. Often the patient complains of pain only and hasn’t noticed a loss of motion. Frequently they develop pain and respond by using their affected shoulder less, which in turn leads to increased stiffness of that shoulder, which leads to even more pain, and so on.
Physical examination in the office is usually enough to diagnose the problem. The sports medicine or shoulder surgeon will examine the shoulder for both active range of motion (the motion the patient can achieve himself or herself) as well as passive motion (the motion that the physician can obtain by moving the shoulder himself or herself). While x-rays are usually normal, it is important to obtain them to rule out any other potential problems. More advanced studies, such as MRI’s, are usually not necessary.
Treatment of a frozen shoulder
Treatment is typically nonsurgical, especially early in the disease process. As adhesive capsulitis progresses through phases, treatment often depends on the phase of the problem. Initially there is a freezing stage where the pain and loss of motion increases. This phase can last for several months. At the peak of the problem (the frozen stage), pain and motion are at their worse. Finally there is a long phase in which pain and loss of motion slowly resolve. Unfortunately this process can take 1-2 years to completely resolve.
Intervention by the sports medicine physician aims to speed the recovery process, and nonsurgical treatment usually works. A combination of physical therapy and stretching exercises, a cortisone injection into the glenohumeral joint of the shoulder, and anti-inflammatory medications can all be tried. If no improvement in motion or pain is obtained and the patient is significantly limited with daily activities or other necessary duties, surgery can be attempted. Surgery can consist of a manipulation under anesthesia, where the surgeon forcefully moves the shoulder to break up adhesions limiting motion while the patient is under sedation. Another option is to surgically release the capsular lining of the shoulder to improve range of motion.
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