Adhesive Capsulitis (Frozen Shoulder)


You are over 40 years of age and have started noticing shoulder pain and stiffness that has occurred spontaneously. You really can’t seem to remember any specific event which caused an initial injury. It seems as though the pain is progressive with an increasing inability to move your arm in any position. This pain is starting to interfere with your sleep now. You are starting to take OTC medications in an effort to reduce the symptoms. You find this helps initially, but no permanent long term affects or resolution. Although the pain might be diminishing, you are definitely experiencing less and less mobility in the shoulder as the months go by. Chances are, you are experiencing Adhesive Capsulitis, or “Frozen Shoulder.”

You may wonder what exactly is going on inside your shoulder to cause this dysfunction. Unlike physical changes your shoulder can experience, such as cartilage and bone degradation with a condition such as Rheumatoid arthritis, the main characteristics of adhesive capsulitis are 1) adhesion formation 2) thickening and 3) restrictions of the shoulder capsule, not bone or cartilage damage.  You might have current or past conditions such as rheumatoid arthritis, rotator cuff syndrome, osteoarthritis, or any tendonopathies that may be playing a contributing factor secondary to your adhesive capsulitis.

There are 3 different phases of Frozen Shoulder, and depending on your specific phase of this dysfunction, you can potentially be experiencing a combination of shoulder joint arthritis, severely diminished ranges of motion (ROMs), and pain.

In the Acute Phase (Phase 1), the primary symptoms are your inability to externally rotate and abduct your arm. Pain is a primary factor, as you notice it radiating (or referring) down to your elbow, and is disturbing your sleep. This phase can be termed “Freezing,” characterized with 2-3 weeks of intense pain and decreased ROMs even at rest. Symptoms may continue as long as 36 weeks.

Subacute Phase, the pain may be experienced in the end ranges of motion. In addition to the specified lack of ROMs in Phase 1, you may now notice a decrease in your ability to internally rotate and flex your arm. This phase can be termed “Frozen” characterized by pain only with movement of the shoulder, adhesion build up, and atrophy of the rotator cuff, biceps/triceps, and deltoid muscles. This can last from 4 to 12 months.

Chronic Phase, your Shoulder joint capsule is now progressively restricted, with significant inability to perform easy tasks such as reaching over your head, opening a jar, driving, or waiving hi to a friend. You may be feeling/experiencing most of your pain as an ache, localizing to the deltoid region. This phase can be termed “Thawing,” characterized with little to no pain, but with significant capsular adhesions and restrictions, which attributes primarily to an overall significant loss of your shoulder’s ROMs. This may last between 2 to 24 months.

What should I do to remedy my problem?

First you need to seek the advice of a professional health care provider (Primary Care Physician including MDs, DCs, or DOs) to accurately diagnose your shoulder problem. Once an accurate diagnosis has been obtained, and it is indeed Adhesive Capsulitis, your doctor should refer you for therapy to either a Licensed Physical Therapist or Chiropractic Physician, who has obtained a secondary Physiotherapy license, to perform the proper procedures. If after treatment your symptoms are unchanged, manipulation under anesthesia (MUA) or a surgical consult should be considered.

What to keep in mind as the patient?

Frozen Shoulder (Adhesive Capsulitis) is more complex of a condition than most ailments. You, as the patient, must understand that treatment for a positive prognosis will take months to attain. Strict adherence to attending your scheduled appointments, as well as performing home exercises prescribed by your therapist, is essential. Basically, you get out what you put in.

If you are experiencing any of the symptoms described above, please schedule an appointment for a consultation and examination with Dr. Richetto today. The sooner an accurate diagnosis is obtained, the sooner your treatment can begin to restoring you back to a better functioning life.

Frozen Shoulder Treatment

What to expect from your treatment plan. As with every patient, conditions will present individualistically. However, with most diagnosis, there are standardized treatment protocols that have been time tested and proven effective for a positive recovery. At RCR, the treatment for Frozen Shoulder will include a step method approach, first with identifying the Phase in which the patient currently presents. Based on that, a specific regimen of the following may be incorporated:

  • Pain free passive ranges of motion
  • Passive joint distraction, Grade 1 & 2
  • Codman's exercises
  • Functional activities
  • Passive joint mobilizations
  • Home exercises
  • Manual/Active stretches
  • Mobilization with active movement
  • Muscle strengthening
  • MUA/surgical consult if necessary