Frozen Shoulder Adhesive Capsulitis - Sugar Land Houston Orthopedic Surgeon

Author: Dr. J. Michael Bennett

Hello, my name is Dr. J. Michael Bennett.

I am a board certified orthopedic surgeon with the Fondren Orthopedic Group. I am a sub specialized sports medicine trained surgeon who specializes in pathology of the shoulder, elbow and knee. Today, we're going to just go over a very quick overview of something called frozen shoulder or adhesive capsulitis. It's a very common pathology that we see in a lot of our patients. Primarily, we see this more often in females that are within their 40s.

They do occasionally have a history of, sometimes, thyroid issues or they can be diabetic. But we can also see it in males that have diabetes as well, and sometimes, we can see this spontaneously occur in the average patient population. But all it is really is, if you think of the shoulder joint as a ball and socket mechanism, the ball and socket is surrounded by what we call a capsule and that capsule is like an envelope around that ball and socket mechanism.

It has a lining, the synovial lining, and around on top of that is the rotator cuff and the tendon. With adhesive capsulitis, what it is is a severe inflammatory process that occurs in the shoulder. Sometimes it could be spontaneous, sometimes it could be associated with a bursitis or a mild shoulder injury but either way, what happens initially is a severe shoulder pain that comes about without really a significant history of trauma. Basically, you go to sleep one night, the next morning you wake up, you start having a little stiffness, a little pain in the shoulder. You move it less and less and less and then all of a sudden, it starts to get frozen. And no matter what you want to do or how you want to do it, you can't lift your shoulder up because something is physically blocking you. So, what that means is that the capsule that surrounds the shoulder, so if this is the ball and the socket looking at front ways, this is looking at the shoulder from the top down.

Frozen Shoulder Adhesive Capsulitis - Sugar Land Houston Orthopedic Surgeon

The capsule is this lining here in the front and the back of the shoulder. So, what happens is the capsule starts to tighten up, it starts to get very, very, very thicken and very inflamed. It happens on the front and the back of the shoulder, it happens below the shoulder itself, down here through the shoulder joint up here and basically, it starts to impede your motion. Unfortunately, the pain becomes so severe that you want to move it less and less. The frozen shoulder usually follows a curve so, what happens is that you start out at the baseline here and you really have mild pain or discomfort.

And all of a sudden, the pain gets severe, severe, severe, really bad to the point that you don't want to move it at all. And then, finally gets to the point where it plateaus. And, the pain actually starts to subside, or it starts to just basically maintain a baseline. What happens at this point here is where it's frozen.

That means you can't move it. What we need to do, as the orthopedic surgeon treating this shoulder, is somewhere during this steep curve right around here, anywhere along this line, we need to intervene and make sure that motion is maintained. Now, maybe very painful working on the motion during this process but, this is the inflammatory phase, this is actually the phase that we can intervene and avoid developing a frozen shoulder which is over here, at this phase. So, if you do have severe shoulder pain and you notice that you're developing a limitation in your motion, definitely seek out the expertise of an orthopedic surgeon to evaluate you because there may be some certain treatment methods that they can incorporate early on this phase to prevent you from getting to the frozen shoulder phase. Because, once you get to this phase, the scar tissue, or the adhesions and the thickness of the capsule, may get to the point where you may actually have to undergo surgery. And, in surgery, what we do is we address this arthroscopically, where we put a camera in the shoulder joint, and what we do is we release these adhesions here and here with a little device that actually breaks up the scar tissue.

And then, while you're asleep, we move your shoulder to gain the adequate range of motion. Now, this process here can last a long time, okay? So most surgeons will probably put you in a physical therapy program, they will probably give you some sort of an anti inflammatory. Sometimes, steroids can be used as well, to actually decrease the inflammation; and maintain you in a physical therapy program sometimes, two to three times a week, to work on range of motion in addition to range of motion at home. Some things that you can do at home to start off to work on your range of motion is something called a wall walking exercise. What you do is you basically face a wall and you put your hand on the wall. Put your hand on the wall and then, you slowly walk up the wall with your finger tips.

As you get as high as you can tolerate, you step towards the wall a little bit further and walk up the wall. Hold it for ten seconds and then, you walk down. Then you do the same thing, turning sideways. Sideways walk up the wall with your fingertips slowly, in a controlled fashion, step towards the wall as high as you can and hold it for a count of ten seconds and walk back down, do not let your hand fall back down, bring it down in a controlled fashion. This will help you maintain your mobility. A lot of patients will do this in the shower in the morning if they have a hot shower because warmth will actually help with the range of motion as well. But in the end, you still need to see an orthopedic specialist just to get the diagnosis to make sure it's correct. Because there are other things that can show up as shoulder pain such as rotator cuff tear, bursitis or biceps tendonitis, you just have to make sure that you're treating, that you're being treated for the right diagnosis.

As I said before, if you have any questions regarding shoulder pathology or any shoulder pain, please feel free to visit our website at orthopedicsportsdoctor.com or call us at 28-1633-8600. Thank you very much.

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