Ask a PT: what is adhesive capsulitis?

“Ask a PT” will be a weekly feature on Fridays in our blog, where we answer questions we get from our clients or posters on this site or our Facebook page.  So if you have a question about some sort of injury or problem you are having whether pain or fitness related drop us a line in the comments or Facebook message, or you can email us at keith@ascent-pt.com.

My shoulder has been hurting for a few weeks now, and someone told me it could be adhesive capsulitis. What is that? Is that the same as frozen shoulder?

True adhesive capsulitis is a relatively rare condition that most commonly affects females between the ages of 40-65.1  Individuals with Diabetes Mellitus type I or II or who have thyroid disease are also at increased risk. Adhesive capsulitis is characterized by shoulder pain that lasts longer than 1 month, sleep disturbance due to pain, an inability to lie on the affected shoulder, and restriction in all active and passive motion, particularly movement that involves rotating the arm outwards. The exact mechanism of adhesive capsulitis is poorly understood, but there is some evidence to suggest that a synovitis/ angiogenesis process in the joint capsule leads to a fibrotic reaction that results in pain and loss of motion.1

“Frozen shoulder” is a more general diagnosis that encompasses a variety of shoulder disorders that result in loss of motion. Frozen shoulder is not necessarily a systemic disease, like adhesive capsulitis may be, and does not indicate a specific treatment.

Adhesive capsulitis, when it is the true diagnosis, follows a fairly predictable pattern divided into 4 stages.1 The first is characterized by sharp pain at end ranges of motion, achy pain at rest, and sleep disturbance.  This phase can last up to 3 months. The next phase is known as the “freezing” stage and results in gradual loss of motion in all directions, lasting 3-9 months.  During this stage, there are changes in the vasculature in the shoulder joint that reflect both an inflammatory process and increased sensitivity that causes pain. The third stage is known as the “frozen stage” and can last between 9-15 months.  The fourth and final stage is called the “thawing” stage and results in decreasing pain.  Increased motion may occur during this stage, but the stiffness and lack of motion can persist up to 2 years.1

Treatment for adhesive capsulitis can include corticosteroid injections, physical therapy that can include stretching, range of motion, and joint mobilizations, and in very severe cases, surgery. Which treatment is best for you depends on how long you have had the condition and how severe/ irritable the shoulder pain is.

A diagnosis of adhesive capsulitis is very specific and is usually not the cause of shoulder pain.  Typically if you do not fall into one of the above categories (female between 40-65 years of age or with a diagnosis of diabetes or thyroid disease), your shoulder pain is more than likely the cause of something else. This includes shoulder stability/movement coordination impairments, shoulder sprain/strain, or rotator cuff pathology/tear.

If you are uncertain about the source of your shoulder pain, you can see a physical therapist or an orthopedic physician for an assessment that can guide your treatment.

1. Kelly et al. Shoulder pain and mobility deficits: Adhesive Capsulitis. J Orthop Sports Phys. 2013;43(5)

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