Adhesive Capsulitis

(Frozen Shoulder)

What is Frozen Shoulder?

Frozen shoulder is a debilitating condition characterized by limited range of motion of the shoulder, often associated with pain.  This pain and limited range of motion is the result of adhesions or scar tissue of the capsule surrounding the shoulder.

What is the cause of Frozen Shoulder?

The cause of frozen shoulder is not fully understood, most often it occurs for no specifically identifiable reason.  Yet, several risk factors exist that increase the odds of getting it. Frozen shoulder more commonly occurs in those with diabetes, thyroid disorders, inflammatory disorders, Dupuytren’s disease, and in women over the age of 40, especially those who are fair skinned.  Frozen shoulder can also develop following shoulder surgery or other trauma, especially after a prolonged period of shoulder immobilization.

 

Symptoms

Frozen shoulder follows a staged course that is often prolonged, requiring anywhere from months to over a year to completely resolve.  The first stage is the inflammatory stage where progressive pain usually precedes loss of shoulder range motion. This stage can last for up to a few months.  The second stage involves persistent shoulder stiffness, while pain may or may not slightly improve during this stage. The final stage is the maturation stage and involves a slow improvement in range of motion and decrease in pain.  Sometimes the loss of motion can persist however.

Because of the persistent and chronic nature of this disease, it is not uncommon for patients to also suffer from mental symptoms such as depression.  This can be addressed by first understanding and acknowledging the severity and length of time that it takes to recover from this disease. If needed, speaking with a qualified psychotherapist or psychiatrist may be helpful.

 

Diagnostic Testing

An x-ray is usually ordered first to evaluate the shoulder joint and to rule out other causes of pain such as arthritis, bone spurs, and loose bodies within the shoulder joint.  While not required to diagnose frozen shoulder, an MRI may be ordered to identify other problems such as rotator cuff tears. 

 

Treatment Options:

Non-operative treatment is often successful, and consists of physical therapy and Anti-inflammatories such as NSAID’s (e.g. Advil or Aleve), and/or Corticosteroid injections.  It is important to remember that recovery from frozen shoulder can take anywhere from months to two years.

Surgical Treatment:

Manipulation Under Anesthesia (MUA) is an option for patients with debilitating pain unresponsive to Physical Therapy, but in general is not offered until at least 3 months of Physical Therapy has been tried.  MUA involves manipulating the shoulder to break up painful adhesions restricting range of motion while the patient is under regional anesthesia. It is often performed with Shoulder Arthroscopy to clean out any scar tissue or adhesions.  The procedure is performed at an outpatient surgical center and usually takes less than 20 minutes to perform.

Dr. Steven Lee is part of the teaching faculty for the Lenox Hill Sports Medicine Fellowship (which is the oldest sports medicine fellowship in the country), and is currently the Associate Director at NISMAT, which is the first institute in the country dedicated to sports medicine research.  Dr. Lee has many years of experience successfully treating frozen shoulder patients, both nonoperatively and operatively.

 

Learn more about scheduling surgery.

Recovery Expectations

Patients who undergo MUA usually start physical therapy as soon as possible after surgery, and is extremely important towards improving motion and decreasing pain.  In general, an additional 6 weeks of physical therapy at least is usually required. Rarely, another manipulation under anesthesia may be necessary if the results are suboptimal or recurrent.  

Immediate Post-Operative Instructions

Please refer to the following pages for more information:

*It is important to note that all of the information above is not specific to anyone and is subject to change based on many different factors including but not limited to individual patient, diagnosis, and treatment specific variables.  It is provided as an educational service and is not intended to serve as medical advice.  Anyone seeking specific orthopedic advice or assistance should consult Dr. Steven Lee or an orthopedic specialist of your choice.

*Dr. Steven Lee is a board certified orthopedic surgeon and is double fellowship trained in the areas of Hand and Upper Extremity Surgery, and Sports Medicine. He has offices in New York City, Scarsdale, and Westbury Long Island.  

© 2019 by Steven J. Lee, M.D. 

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