Is frozen shoulder the same as adhesive capsulitis?

No, they are different. Frozen shoulder is a general term used to describe any shoulder that is stiff. Adhesive capsulitis is a very specific term for a condition that involves the spontaneous, gradual onset of shoulder stiffness and pain caused by tightening of the joint capsule.

What causes adhesive capsulitis?

It occurs as the capsule around the shoulder joint thickens and contracts. However, the reason for this is not fully understood. It sometimes occurs when the shoulder is immobilised for some time (eg: when a patient is bedridden after surgery). Inactivity due to ageing is another factor that contributes to this condition. Adhesive capsulitis is more common among people with diabetes and is also linked with other medical conditions such as cardiac disease and Parkinsonism.

Do I have adhesive capsulitis?

Try to reach your hands from behind (put one arm behind your back, raise the other arm up and bend it over your shoulder and reach for the fingers of the other hand: as illustrated here). If you are unable to stretch and touch the fingertips, it is likely that you are suffering from a stiff shoulder. Over time this would eventually restrict most of your upper limb movements and may cause you pain with the slightest movement. So do not neglect the condition. Do some upper arm stretches and movements to avoid its later stage complications.

Signs and symptoms of adhesive capsulitis?

Symptoms associated with this condition usually develop gradually over time. Patients typically experience a dull ache that may increase to a sharper pain with certain movements or activities. Pain tends to be focused deep in the shoulder, however may occasionally be experienced in the upper arm, upper back and neck. Patients may also experience stiffness in each of these regions. There is no sudden onset of pain, no injury or event to explain it, it just gradually appears and steadily increases (however an injury to shoulder/arm can trigger the adhesive capsulitis).

Restrictions in the shoulder movements develop over time (eg: elevating the arm, lifting/ carrying, pushing/pulling motions can get difficult). People often experience pain at night or intense pain upon waking up in the morning. Although adhesive capsulitis generally affects only one side, some patients may develop the condition in both shoulders.
Your medical practitioner or a physiotherapist will exclude other causes of shoulder problems before “adhesive capsulitis” is diagnosed.

Stages of adhesive capsulitis

They can generally be divided into three phases, each of which can last a number of months.

•  Painful phase – In this first phase, the shoulder typically becomes painful with most movements. The shoulder may also start to stiffen during this phase. The pain can be severe and unrelenting, leading to problems while sleeping.
•  Freezing / stiffening phase – The second phase of this condition is characterised by a marked loss of movement of the shoulder, coinciding with scarring of the shoulder joint capsule. Patients typically experience difficulty when elevating the arm or taking their hand behind their back.
•  Thawing/recovery period – In this final phase, the shoulder spontaneously begins to ‘loosen’ up and movement to the shoulder is gradually restored. Recovery is often not complete, with mild pain and stiffness a common long term problem, without however any significant functional disability.

Treatment options

Physiotherapy treatments with exercises are often the best recommended. However there are other options of combination of therapy procedures available:

• Pain killers & steroid injections
• Manipulation under anaesthesia
• Open or arthroscopic surgery

Physiotherapy for adhesive capsulitis

The focus of physiotherapy when treating adhesive capsulitis would be to minimise the pain and maintain the range of movements and functions.

•  Rest – Rest to ensure the healing process (avoid activities which may increase the pain Eg: avoid sleeping on the affected arm).
•  Activities – Patients are advised to perform activities pain free to maintain the available range of motion and look to a gradual return to activities
•  Precautions – When inflammatory signs are present take precautions to avoid further damage. Keep ice on the shoulder, keep the arm elevated-rest your arm on a pillow, sleep in the other direction. If swelling is observed use anti-inflammatory medications. (under medical practitioner’s guidance)
•  Electrotherapy – Infra-red radiations, Short wave diathermy, Ultrasound and Interferential therapy helps to reduce the pain and inflammation as well as helps to restore the damage and accelerate the healing process.
•  Exercise therapy– You should perform pain-free flexibility and strengthening exercises. Your physiotherapist will do postural corrections, activity modifications and joint mobilizations to prevent further stiffness and maintain the available strength of the shoulder muscles. The physiotherapist will further advise you about exercises that are most appropriate for you and when they should be commenced. Eg: pendulum swing-like movement of your arm, finger walk in the wall. (as illustrated in the picture)
•  Maintenance– It is important to continue your daily exercise regime because when the joint becomes inactive, the symptoms would gradually appear. It is recommended that you follow exercises on both shoulders to avoid getting a stiff shoulder on the other side.

A gradual return is needed when going back to your daily activity routines. Your physiotherapist will guide you and advise you on how to maintain the acquired range of motion of the affected shoulder. Activities such as swimming, walking with free arm swing are generally recommended.

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