Adhesive Capsulitis

Adhesive capsulitis, commonly called “frozen shoulder,” is a condition that causes pain and stiffness in the shoulder joint. Over time, the shoulder becomes harder to move, and everyday activities like reaching overhead, getting dressed, or sleeping comfortably can become difficult.

The condition develops when the connective tissue surrounding the shoulder joint, known as the capsule, becomes thickened and tight. This restricts movement and can lead to significant discomfort. Frozen shoulder typically develops slowly and progresses through stages, often lasting months or even years if not treated. While it can affect anyone, it is most common in adults between the ages of 40 and 60, and it tends to occur more often in women than in men.

What are the symptoms?

The symptoms of adhesive capsulitis usually appear gradually and worsen over time. The first and most noticeable symptom is pain in the shoulder, which may start as a dull ache and become more persistent. This pain is often felt on the outer shoulder and sometimes radiates down the upper arm. It may worsen at night, making it hard to sleep on the affected side.

As the condition progresses, stiffness becomes more prominent. People often notice a reduced range of motion, meaning they cannot move their shoulder as freely as before. Simple tasks such as reaching for an item on a shelf, fastening a seatbelt, or putting on a jacket may become challenging.

Frozen shoulder typically develops in three stages. In the “freezing” stage, pain increases and movement becomes more limited. In the “frozen” stage, pain may lessen somewhat, but stiffness remains and can be quite severe. In the “thawing” stage, shoulder movement gradually improves, although this recovery can take time. The entire process can last from 1 to 3 years, but most patients improve with proper care.

What causes adhesive capsulitis?

The exact cause of adhesive capsulitis is not always clear.

• Adhesions: It occurs when the shoulder capsule becomes inflamed and thickened, leading to the formation of tight bands of tissue that restrict movement. This process reduces the space within the joint and limits how the shoulder can move.
• When the shoulder is not used for an extended time, such as after surgery, injury, or illness, the risk of developing frozen shoulder increases. For example, someone recovering from a broken arm, rotator cuff injury, or stroke may avoid moving the shoulder, which can lead to stiffness and eventually adhesive capsulitis. Lifestyle and medical history can contribute as well. Even prolonged inactivity due to unrelated health issues can increase the chances of developing this condition.
• Inflammation plays a key role. In some cases, underlying conditions that affect the body’s inflammatory response may contribute to the development of frozen shoulder. Even though the condition can sometimes appear without a clear reason, these factors often help explain why it occurs.
• Several factors can increase the likelihood of developing adhesive capsulitis. Age is one of the most important risk factors, with people over 40 being more commonly affected. Gender also plays a role, as women are more likely than men to develop the condition.

Certain medical conditions are strongly linked to frozen shoulder. Diabetes is one of the most significant risk factors, and people with diabetes are more likely to develop adhesive capsulitis and may experience more severe symptoms. Other conditions, such as thyroid disorders, heart disease, and Parkinson’s disease, have also been associated with an increased risk.

Understanding these risk factors can help patients and healthcare providers take steps to reduce the likelihood of frozen shoulder, especially after an injury or surgery. Early movement and guided rehabilitation are often recommended to help maintain shoulder flexibility.

How is frozen shoulder diagnosed?

Diagnosing adhesive capsulitis typically begins with a thorough medical history and physical examination. An Orthopedic clinician will ask about symptoms, how long they have been present, and whether there has been any recent injury, surgery, or period of limited shoulder use.

During the physical exam, they will assess both active and passive range of motion. Active range of motion refers to how far a patient can move their shoulder on their own, while passive range of motion is how far the shoulder can be moved with assistance. In frozen shoulder, both types of movement are usually limited, which helps distinguish it from other shoulder conditions.

Imaging tests may also be used to confirm the diagnosis or rule out other problems. X-rays can help identify issues such as arthritis or bone abnormalities. In some cases, an MRI or ultrasound may be recommended to evaluate the soft tissues of the shoulder and ensure there are no other injuries, such as a rotator cuff tear.

A clear and accurate diagnosis is important because the symptoms of adhesive capsulitis can overlap with other shoulder conditions. Identifying the condition early allows for appropriate treatment and can help prevent further loss of motion.

Adhesive capsulitis can be frustrating, but understanding the condition is the first step toward recovery. With proper care and guidance, most people experience significant improvement over time and regain the ability to move their shoulder more comfortably.

Contact Orthopedic Associates of Northern California to schedule a consultation to receive the correct diagnosis and all your treatment options. Our goal is to get you back to the life you love.