The shoulder is a complex anatomic structure that allows movement in many planes. Patients often ignore the importance of the shoulder joint until its function becomes compromised. It then becomes obvious how crucial it is for many essential activities. The expression “If you don’t use it, you lose it” applies perfectly to diseases of the shoulder because any voluntary or involuntary guarding of the shoulder may result in loss of mobility.

Your shoulder is made up of three bones that form a ball-and-socket joint. There’s also tissue surrounding your shoulder joint that holds everything together. This is called the shoulder capsule.

The term “adhesive capsulitis” has been applied to conditions when the shoulder is working at less than its optimal range. Because the shoulder joint is so complex, it is important to determine the precise cause for loss of shoulder mobility. It is paramount that physicians use proper terminology so that they can communicate effectively and treat patients appropriately.

What is Adhesive Capsulitis?

Adhesive Capsulitis, also called Frozen Shoulder, is a painful condition in which the movement of the shoulder becomes limited.

Adhesive Capsulitis occurs when the strong connective tissue surrounding the shoulder joint (called the shoulder joint capsule) become thick, stiff, and inflamed. (The joint capsule contains the ligaments that attach the top of the upper arm bone [humeral head] to the shoulder socket [glenoid], firmly holding the joint in place. This is more commonly known as the “ball and socket” joint.)

The condition is called “frozen” or “Adhesive” shoulder as it becomes stiff, because the more pain that is felt, the less likely the shoulder will be used. Lack of use causes the shoulder capsule to thicken and becomes tight, making the shoulder even more difficult to move — it is “frozen” in its position.

Aetiology/Causes:

• The bones, ligaments and tendons that make up your shoulder joint are encased in a capsule of connective tissue. Frozen shoulder occurs when this capsule thickens and tightens around the shoulder joint, restricting its movement.
• Presently doctors being unclear for this condition. although it’s more likely to occur in people who have diabetes or those who recently had to immobilize their shoulder for a long period.
• The pathos-aetiology of adhesive capsulitis is, however, complex and multifactorial with both geneticand environmental factors playing an important role.
• However, there is a hypothesis based on arthroscopic and pathologic observations, that there is an inflammatory component within the axillary fold. This is followed by stiffness and adhesions, which results in fibrosis of the synovial lining, which is associated with the inflammation.

Hence there are two categories for the adhesive capsulitis/ Frozen Shoulder:

• Primary– Onset is generally idiopathic (it comes on for no attributable reason).
• Secondary– Results from a known cause, predisposing factor or surgical event. For example, post-surgery, post-stroke and post-injury, an arm fracture.

Where post-injury, there may be an altered movement patterns to protect the painful structures, which will in turn change the motor control of the shoulder, reducing the range of motion, and gradually stiffens up the joint.

Three subcategories of secondary frozen shoulder include:

• Systemic(diabetes mellitus and other metabolic conditions);
• Extrinsic factors(cardiopulmonary disease, cervical disc, CVA, humerus fractures, Parkinson’s disease);
• Intrinsic factors(rotator cuff pathologies, biceps tendinopathy, calcific tendinopathy, AC joint arthritis).

People 40 and older, particularly women, are more likely to have frozen shoulder.

Incidence:

Adhesive capsulitis has an incidence of 3–5% in the general population and up to 20% in those with diabetes. This disorder is one of the most common musculoskeletal problems seen in orthopaedics .Although some have described adhesive capsulitis as a self-limiting disorder that resolves in 1–3 years other studies report ranges of between 20 and 50% of patients with adhesive capsulitis which suffer long-term range of motion (ROM) deficits that may last up to 10 years .

The typical patient that develops adhesive capsulitis is a female in her 5th to 7th decade of life. Adhesive capsulitis is commonly associated with other systemic and no systemic conditions. By far the most common is the co-morbid condition of diabetes mellitus, with an incidence of 10–36% .

Other co-morbid conditions include hypoadrenalism, Parkinson’s disease, hyperthyroidism, pulmonary disease, hypothyroidism, cardiac disease, stroke, and even surgical procedures that do not affect the shoulder such as cardiac surgery, cardiac catheterization, neurosurgery, and radical neck dissection.

Symptoms:

 

Frozen shoulder typically develops slowly, and in three stages. Each stage can last a number of months.

• The “freezing” stage.Any movement of your shoulder causes pain, and your shoulder’s range of motion starts to become limited. In this stage, the shoulder becomes stiff and is painful to move. The pain slowly increases. It may worsen at night. Inability to move the shoulder increases. This stage lasts 6 weeks to 9 months.
• The “frozen” stage:Pain may begin to diminish during this stage. However, your shoulder becomes stiffer, and using it becomes more difficult. During frozen stage pain may lessen, but the shoulder remains stiff. This makes it more difficult to complete daily tasks and activities. This stage lasts 2 to 6 months.
• The “thawing” (recovery) stage: The range of motion in your shoulder begins to improve. In this stage, pain lessens, and ability to move the shoulder slowly improves. Full or near full recovery occurs as normal strength and motion return. The stage lasts 6 months to 2 years.

Prevention:

• One of the most common causes of frozen shoulder is the immobility that may result during recovery from a shoulder injury, broken arm or a stroke. If you’ve had an injury that makes it difficult to move your shoulder, talk to your doctor about exercises you can do to maintain the range of motion in your shoulder joint.

However Adhesive capsulitis is a musculoskeletal condition that has a disabling capability. The early diagnosis can be cured with non-operative treatments. But if the condition is ignored for the long time it can be turned into serious one which has to go under operative management for recovery.