Frozen Shoulder (Adhesive Capsulitis)

The shoulder is a ball-and-socket joint consisting of three main bones:

• Humerus (upper arm bone)
• Scapula (shoulder blade)
• Clavicle (collarbone)

The glenohumeral joint is the primary joint involved in shoulder movement, where the head of the humerus fits into the glenoid cavity of the scapula. Surrounding this joint is the shoulder capsule, a fibrous envelope that maintains stability while allowing mobility. The capsule is lined with the synovial membrane, which produces synovial fluid to lubricate the joint.

The rotator cuff, consisting of four muscles (supraspinatus, infraspinatus, teres minor, and subscapularis), provides dynamic stability and assists with shoulder movements. The coracohumeral ligament and glenohumeral ligaments contribute to passive stability.

In adhesive capsulitis, the following anatomical structures are affected:

• Fibrosis and Thickening of the Shoulder Capsule: The capsule becomes inflamed and progressively stiffens, reducing its ability to stretch and move.
• Synovial Inflammation: The synovial membrane may become inflamed, leading to pain and irritation.
• Rotator Cuff and Surrounding Musculature: While the rotator cuff itself is not directly affected, the surrounding muscles may become stiff due to compensatory movement patterns and disuse.
• Coracohumeral Ligament Tightening: The coracohumeral ligament often becomes contracted, further limiting external rotation of the shoulder.

Adhesive capsulitis typically progresses through three stages:

Freezing Stage (Painful Stage) – Lasts 6 weeks to 9 months:

• Gradual onset of shoulder pain, often worsening at night.
• Progressive loss of range of motion, particularly external rotation.
• Increased discomfort with movement.

Frozen Stage (Stiffening Stage) – Lasts 4 to 12 months:

• Pain may decrease, but stiffness becomes more pronounced.
• Severe restriction in shoulder movement, making daily activities difficult.
• Weakness may develop due to disuse.

Thawing Stage (Recovery Stage) – Lasts 6 months to 2 years:

• Gradual improvement in range of motion.
• Shoulder function slowly returns to normal or near normal.

Most cases of adhesive capsulitis resolve with conservative management. Treatment options include:

Physical Therapy:

• Stretching exercises to improve flexibility and restore range of motion.
• Strengthening exercises to prevent muscle atrophy and maintain shoulder function.
• Manual therapy, such as joint mobilizations, to decrease stiffness.

Pain Management:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen.
• Corticosteroid injections to reduce inflammation and provide temporary pain relief.
• Heat therapy and ice packs to manage pain and stiffness.

Home Exercises:

• Pendulum exercises, towel stretches, supine stretches, cross-body stretches to maintain mobility.

If conservative treatments fail to provide relief after several months, surgical options may be considered:

Arthroscopic Capsular Release and Manipulation Under Anesthesia (MUA):

• A minimally invasive procedure where small incisions are made, and specialized instruments are used to cut and release the tight shoulder capsule.
• After release of capsular tissue, the shoulder is forcibly moved while the patient is under anesthesia to break up adhesions and improve mobility.
• Combined with immediate physical therapy for optimal recovery.
• There is a risk of complications such as fractures or soft tissue injury.

Open Surgery (Rare Cases):

• Reserved for severe, refractory cases where arthroscopic treatment is insufficient.