Frozen Shoulder (Adhesive Capsulitis)
One of the most common physical complaints is shoulder pain. Your shoulder is made up of several joints combined with tendons and muscles that allow range of motion in your arm. Because so many different structures make up the shoulder, it is vulnerable to many different problems.
Your shoulder is made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle).
Your arm is kept in your shoulder socket by your rotator cuff and shoulder joint capsule. These muscles and tendons form a covering around the head of your upper arm bone and attach it to your shoulder blade (scapula). There is a lubricating sac called a bursa between the rotator cuff & the bone on top of your shoulder (acromion).
Frozen shoulder occurs when the capsule and ligaments of the shoulder tighten up, which leads to loss of active and passive range of motion and pain.
Frozen shoulder may occur more commonly in patients with diabetes or thyroid disease, but often the primary reason it occurs is unknown or seems to come “out of nowhere.” Another cause of frozen shoulder is called post-traumatic, usually from a fracture, rotator cuff tear, or injury. Lastly, patients can develop adhesions after surgery, such as after a rotator cuff repair.
X-rays will not show the soft tissues of your shoulder like the rotator cuff or ligaments. Plain x-rays of the shoulder with frozen shoulder are usually normal. An MRI may be ordered when x-rays do not show any definitive problems, and frozen shoulder can usually be noted on an MRI, as thickening of the capsule.
The goal of treatment is to reduce pain and restore function. In planning your treatment, your doctor will consider your age, activity level, and general health.
The vast majority of the time (greater than 95% of patients), frozen shoulder is treated non-surgically, and will resolve on it’s own. However, resolution can take more than 1 year, which can be very frustrating for patients. To help speed up the process, Dr. Fleager will recommend:
- Non-steroidal anti-inflammatory (NSAIDs) medicines, such as Ibuprofen and Aleve, to reduce pain and inflammation.
- Physical therapy to help restore normal motion to your shoulder and strengthen the supporting musculature of the shoulder. (VERY IMPORTANT!)
- Steroid injection to reduce inflammation & pain. Dr. Fleager will usually start with a series of 3 steroid injections, 1 month apart.
If you have participated in >6 months of therapy and injections, and have not seen any improvement, surgical intervention will be considered.
This is arthroscopic surgery, which is minimally invasive, using very small incisions and a camera in the shoulder joint. The goal of surgery is to remove adhesions or scar tissue and increase range of motion. Dr. Fleager may also perform a manipulation, meaning she moves your shoulder for you while your asleep to also assist in breaking up scar tissue.
Dr. Fleager may also treat other conditions present in the shoulder at the time of surgery, such as bursitis and AC joint arthritis. You will be placed into a sling and allowed to go home the same day of surgery. Physical therapy will begin either that day or the following day.