Adhesive capsulitis, also referred to as frozen shoulder, is often a painful and severely limiting shoulder condition. Onset of this pain and stiffness can occur suddenly with or without previous shoulder issues. It typically occurs in women and those older than 45 years.
Adhesive capsulitis, or frozen shoulder, is characterized by severe pain and stiffness of the shoulder joint. It may feel achy when it is resting, but the pain will become sharp once you start to move and use it. There are multiple stages to frozen shoulder:
Stage 1. “Pre-freezing”: This is the stage when you first start noticing sharp pain in the shoulder over 1 to 3 months without any sign of improvement. You may start to realize your motion with rotating your shoulder out to the side as if to put your jacket on or reaching behind your belt is both limited and very painful.
Stage 2: “Freezing”: During the freezing stage, you may have had pain and limited mobility for about 3 to 9 months. You will likely experience greater pain, limitations, and pain at night.
Stage 3: “Frozen”: When you have reached the frozen stage, you have likely experienced pain and stiffness for 9 to 14 months and your symptoms have peaked. By about 14 months, you should start to feel less pain when you are not moving and only discomfort when you stretch your shoulder to its end limits.
Stage 4: “Thawing”: During this last phase around 12-15 months, your shoulder symptoms slowly start to decrease. Your pain decreases and your mobility improves.
Please note, however, that these time frames may differ from person to person.
Adhesive capsulitis occurs when the connective tissue that covers the joint deep to the shoulder surface thickens and stiffens. The thickening of this tissue is responsible for the restrictions in movement. There is no known cause of adhesive capsulitis, but some theories include inflammation in the shoulder or systemic inflammation (such as an autoimmune disease), post surgery complications, pain after surgery or injury resulting in immobilization and subsequent stiffness.
Pain and stiffness in the shoulder can mimic a variety of diagnoses. However, physical therapists at Specialized Physical Therapy are trained to identify this diagnosis by what is known as a “capsular pattern.” A capsular pattern is a specific pattern of movement loss that is seen with frozen shoulder. The capsular pattern of the shoulder is when your shoulder external rotation motion (rotating the arm out to the side) is more limited than the abduction motion (raising arm out to the side), which is more limited than internal rotation (reaching your arm behind your back).
Treatment and Exercises
After a thorough examination of your presentation, your physical therapist will create a comprehensive exercise program to regain your mobility, improve your posture, and increase your strength to return you to your prior level of function and recreational activities. Your physical therapist will also identify different ways to make you more comfortable throughout the day and at night, such as different sleep positioning and home exercises to perform. The goal of therapy will to maximize your shoulder mobility throughout each phase as quickly as possible.
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