Adhesive Capsulitis

Overview

What is adhesive capsulitis?

Adhesive capsulitis (say: “add-he-sive cap-sool-eye-tis”) is when you lose the ability to move your shoulder around in all directions without pain. Doctors sometimes refer to this problem as “frozen shoulder” because your shoulder can become stiff and it may be difficult for you to move it at all.

Symptoms

What are the signs of adhesive capsulitis?

You should be able to move your shoulder in all directions without pain or stiffness. To test your shoulder movement, do these things:

  • Reach up toward the sky with both arms.
  • Reach your arms out straight in front of you.
  • Raise your arms out to the sides of your body.
  • Pretend that you are trying to unzip the back of your dress or pull your wallet from the back pocket of your pants.

Does my shoulder actually freeze?

No, sometimes adhesive capsulitis can cause your shoulder to just stop moving. This happens because if you don’t use your shoulder enough (because it hurts to move) or if you use it the wrong way, your shoulder will develop scar tissue that stops it from moving around easily. Your shoulder may go through several stages as the scar tissue forms, and it may get better on its own.

  1. The painful stage. At first, your shoulder may ache and feel stiff. Then it may get very painful. This stage may last about 3 to 8 months.
  2. The adhesive stage. During the second stage, you may not actually have as much pain, but your shoulder keeps getting stiffer. This stage usually lasts about 4 to 6 months.
  3. The recovery stage. The final stage, which usually lasts about 1 to 3 months, isn’t very painful. It becomes very hard to move your shoulder even a little bit. Then after a while, the stiffness slowly goes away. You can move your shoulder again. Although you may not get the full movement of your shoulder back, you should be able to do many more activities. As your shoulder movement increases, you may still have pain at times.

Causes & Risk Factors

What causes adhesive capsulitis?

Adhesive capsulitis develops when the connective tissue in your shoulder joint tightens and restricts your joint’s movement. Often, this occurs after a time when you have been less active because of another injury, such as a rotator cuff injury, broken arm or recovering from a surgery.

People 40 years of age and older are at higher risk for adhesive capsulitis, especially women. Certain health conditions, including diabetes, can also put you at higher risk.

Diagnosis & Tests

How is adhesive capsulitis diagnosed?

Your doctor may be able to tell you have adhesive capsulitis just by talking to you about your symptoms and watching you move. Your doctor may press on parts of your shoulder to see what might be causing the pain. Your doctor may also want to take an X-ray or do a magnetic resonance imaging (MRI) scan of your shoulder to look for other problems.

Treatment

How is adhesive capsulitis treated?

Your doctor will tell you about exercises you can do to help break up the scar tissue in your shoulder. You may need to see a physical therapist to help you with these exercises. You can try the exercises listed below at home, but remember to always follow your doctor’s instructions.

Sometimes the exercises hurt, so your doctor may give you something for the pain or to relax your muscles. Putting a heating pad or an ice pack on your shoulder for a few minutes before you do the exercise may also help with the pain. Always remember to warm up for 5 to 10 minutes before starting your exercises. Warm up by doing very gentle exercises and small movements with your shoulder. Don’t forget to warm up and stretch other parts of your body (neck, back, hands and elbows), too.

Here are 3 good exercises you can try:

  • Climbing the wall: Put your hand flat on a wall in front of you. Use your fingers to “climb” up the wall (like a “spider”). As you move your fingers up little by little, stop and hold your hand in place for 30 seconds every few inches. Move your fingers up the wall as high as you can reach. Keep trying to go higher.
  • Codman exercise: Sit sideways in a straight chair. Rest your armpit on the back of the chair. Now swing your arm slowly in circles. Make little circles at first and then make bigger circles. Make the circles in both directions.
  • Reaching: Put things you use every day (shoes, coffee cup, toothbrush) on a high shelf. This way you have to reach up for things more often. The reaching is a good stretch for your shoulder.

Do the exercises once or twice a day even after your shoulder gets better. Don’t forget to exercise your healthy shoulder too, so that you can maintain the movement that you have in that shoulder.

Many people who have adhesive capsulitis get full use of their shoulder back. Others may always have a little stiffness and pain in that shoulder. This stiffness is usually not very bad. You should be able to do all the activities you did before you had adhesive capsulitis.

Questions

Questions to Ask Your Doctor

  • What is the likely cause of my adhesive capsulitis?
  • What is the best treatment option for me?
  • How long before I can expect relief from my symptoms?
  • Is it possible that my symptoms could return?
  • Is it safe for me to exercise? What kind of exercise should I do?

Citations

  • Adhesive Capsulitis: A Sticky Issue by LB Siegel, M.D., NJ Cohen, M.D., and EP Gall, M.D.( 04/01/99, http://www.aafp.org/afp/990401ap/1843.html)