Adhesive capsulitis, commonly referred to as frozen shoulder, involves inflammation in the joint that causes the looser parts of the joint capsule to "freeze" or stick together. The condition generally resolves by itself, but it carries a high degree of pain and dysfunction and can take several months to a year or more to heal. Because of this, those who have the condition should seek treatment to speed healing rather than let a frozen shoulder run its course. In a majority of cases--up to 90 percent, according to the American Academy of Orthopaedic Surgeons--surgical intervention is not required. There is some mystery to why adhesive capsulitis occurs; because of this, treatment options vary by case.
Reduce Inflammation
Initially, treatment aims in part to limit inflammation, thickening and adhesions in the joint capsule. NSAIDS (nonsteroidal anti-inflammatory drugs), cold therapy or steroid injections in combination with anesthetic agents help treat the area. If there is a strong autoimmune component at work, these treatments have variable results and progress can be slow. If this treatment is successful, within four months a person should see less pain and restriction than before treatment began.
Physical Therapy
Physical therapy is vital to restoring and preserving joint range of motion. Applying heat, such as with heating pads or heat lamps, in the noninflammatory stage will help soften muscles and joint tissues in preparation for stretching, massage, joint mobilization or use of modalities such as ultrasound and electrical muscle stimulation. Because muscles will atrophy if they are not used while pain and inflammation exist, the transition must be made slowly from passive therapies with help from a therapist toward increasingly independent strengthening exercises the patient carries out himself.
Surgical Options
If noninvasive avenues have been exhausted, two surgical methods are available to help a frozen shoulder. A patient can undergo manipulation of the joint under full anesthesia. This option is usually done in the condition's earlier stages. During the procedure, a surgeon manually manipulates your shoulder by forcing it to go through its normal range of motion. The aim is to stretch and break up adhesions and scar tissue to restore function in the area. Complications may involve tearing of soft tissues, inflammation or damage to surrounding nerves, blood vessels or bones.
Arthroscopic surgery, also known as "capsular release," is usually performed in more advanced stages. This procedure involves separating adhesions within the joint capsule. To accomplish this goal, fine-gauge instruments are inserted through tiny incisions around the joint, and then guided with fiber optics to cut through tight portions of the joint capsule and the coracohumeral ligament. Recovery time is quicker with this method than with manipulation under anesthesia, but arthroscopic surgery may need repeating several times to achieve a satisfactory result. Recovery time for surgical options can take from three months up to a year.
