Adhesive capsulitis treatment
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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Frozen shoulder, or adhesive capsulitis, is a condition that causes loss of range of motion in the shoulder.
The diagnosis of frozen shoulder is often used to describe any painful shoulder condition associated with a loss of range of motion, but that is probably simplistic.
Other conditions can also cause restricted motion and a stiff joint. Often people have experienced an injury to the shoulder prior to the onset of frozen shoulder, but often there is no underlying cause for developing a frozen shoulder.
The shoulder joint is a ball and socket joint. The ball is the top of the arm bone (the humeral head), and the socket is part of the shoulder blade (the glenoid). Together these bones form the glenohumeral joint.
The shoulder joint is usually the joint with the most range of motion in the body. When frozen shoulder occurs, there is porofound loss of motion and associated pain.
The condition is characterized by a decrease in motion with elevating the arm and rotating it inwards. Frozen shoulder occurs most commonly in the 40-60 year old age group and it is twice as common in women as men. People usually experience pain as the first symptom of frozen shoulder, followed by the loss of motion and a decrease in pain. In many instances there is a gradual return of motion; however, the length of time for recovery from frozen shoulder can be extended, with an average duration of 18 months.
Frozen shoulder treatment primarily consists of pain relief and physical therapy. Exercises and stretching for frozen shoulder serve two functions:
• increase the motion in the joint
• minimize the loss of muscle mass in the affected arm
Physical therapists may also use ultrasound, ice, heat, and other modalities in the rehabilitation of a frozen shoulder.
Glucocorticoid injections are also commonly used to decrease the pain in the frozen shoulder joint. Usually up to three injections can be given, over 12 weeks. After three injections, if improvement is not seen it is unlikely that more injections will alter the course of frozen shoulder treatment. There is evidence that glucocorticoids may actually lead to more cartilage damage so their use should be limited.
If the above treatments do not fix the frozen shoulder, a patient may need to have surgery. If this is the case, the surgeon may perform a manipulation under anesthesia. The purpose is to break up adhesions that have caused the frozen shoulder.
Sometimes arthroscopic treatment is required. An arthroscope can be inserted into the joint to lyse (cut through) adhesions. This procedure is called an arthroscopic capsular release. Surgical capsular release of a frozen shoulder is rarely necessary, but it is extremely useful in cases of frozen shoulder that do not respond to conservative therapy. If surgery is performed, physical therapy following the capsular release is important. This is to prevent the chance of recurrence.
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