Orthopedics

OSPI offers the top orthopedic surgeons in Gilbert AZ and the East Valley. Drs. Mahoney, Macqueen, Stewart and Clouse offer minimally invasive General, Sports and Joint Replacement expertise.

Physical Therapy

Whether you are pre or post-operative, OSPI’s East Valley physical therapy team works with you on both active and passive treatments. Your will be in the best hands with our licensed physical therapists!

Chiropractic

The Gilbert chiropractors at OSPI offer a plethora of nonoperative pain relief options such as manipulations, laser therapy, physiotherapy and electrical stimulation.

Family Practice

OSPI offers comprehensive family practice services including allergy testing, BHRT, medical weight loss, aesthetics and full check ups.

Medical Weight Loss

Patients routinely experience dramatic, healthy weight loss with the customized programs at OSPI. The programs combine nutrition, exercise and prescription weight loss options.

Performance Training

OSPI’s integrated team of healthcare providers work with both amateur and professional athletes to maximize one’s performance with sport specific programs.

Pain Management

OSPI’s Board Certified, Fellowship Trained pain doctor offers both medication management and interventional procedures with exceptional outcomes!

Shoulder Adhesive Capsulitis (Frozen Shoulder)

FAQS on Shoulder Adhesive Capsulitis (Frozen Shoulder)

Common in people aged above 40, shoulder adhesive capsulitis, known as frozen shoulder to a layman, impacts about 2-5% of Americans regardless of gender and occupation. What begins as mild stiffness in the shoulder gradually becomes very hard making shoulder movement painful and resulting in the loss of motion. Patients have a range of treatment options, including surgery and non-operative pain management injections.

What is shoulder adhesive capsulitis or frozen shoulder?

Shoulder adhesive capsulitis refers to significant stiffness in the joint making the shoulder tight and inflexible with less room for movement. It gives the feeling of adhesion in the shoulder joint that makes bones fixed. The limitations on shoulder motion cause intrinsic pain whenever the arm is moved in any direction.

The glenohumeral disorder can impact one or both shoulders in three phases.

  • The freezing phase when ligament thickening or contraction causes shoulder rigidity.
  • The frozen phase when you have limited shoulder motion and shoulder joint pain. The condition worsens.
  • The thawing phase when pain subsides gradually and shoulder mobility increases.

What are the symptoms of shoulder adhesive capsulitis or frozen shoulder?

  • Gradual stiffness in the shoulder
  • Painful arc of motion
  • Aching pain in shoulder and upper arm
  • Loss of rotation and elevation movements in shoulders
  • Limited ability to lift the hand, push, pull, or touch your back
  • Pain increases with shoulder use and becomes sharper
  • Decreased external rotation
  • Shoulder frozen in the morning
  • Associated stiffness in neck, upper arm, and back
  • Muscles wasting as the condition worsens

How does it occur?

Adhesive capsulitis or frozen shoulder occurs when the layer of ligaments around the glenohumeral joint thickens. The name “adhesive capsulitis” is derived from a combination of Latin (adhaerens capsula) and Greek (itis) words. The Latin words mean “sticking to the container” while the Greek word refers to “inflammation.”

Swelling and stiffening of the ligaments lead to contraction of the shoulder joint capsule. As a result, the connective sac of soft tissues thickens and adhesions are formed restricting the shoulder mobility. It worsens over time developing frozen shoulder disorder with pain and loss of motion.

What are causes of shoulder adhesive capsulitis or frozen shoulder?

  • Injury or fracture in the shoulder
  • Stiffness in the shoulder
  • Inflammation of the shoulder joint capsule/ ligaments
  • Diabetes, strokes, chest surgery, hyperthyroidism, Parkinson’s disease
  • Breast surgery in women
  • Rotator cuff injury
  • Chronic inflammatory arthritis
  • Formation of scar tissues in the shoulder joint
  • Shoulder bursitis
  • Thickening of shoulder ligaments
  • Shoulder immobilization for long period
  • Dupuytren’s contracture

Who are at the risk of shoulder adhesive capsulitis or frozen shoulder?

Shoulder adhesive capsulitis is more common in women than men. People with following conditions are at the increased risk of suffering from frozen shoulder syndrome.

  • Over 40 years
  • Arm fracture or shoulder surgery
  • Shoulder immobility following surgery
  • Heart stroke or history of diabetes
  • Thyroid problem
  • Cardiovascular disorder
  • Parkinson’s disease

How is shoulder adhesive capsulitis or frozen shoulder diagnosed?

  • Physical evaluation: Doctors ask patients to perform a range of passive and active shoulder movements. Symptoms enable them to conclude if the disorder is frozen shoulder syndrome.
  • Numbing injection: An anesthetic injection helps pinpoint the exact nature of pain and if the underlying reason is inflamed shoulder joint capsule.
  • Imaging tests: To rule out any other shoulder condition, x-ray and MRI tests may be recommended.

What are the treatment methods available for shoulder adhesive capsulitis or frozen shoulder?

  • Medication: Usually, frozen shoulder disorder improves and patients regain mobility within 12 to 18 months. However, pain and immobility forces many to be treated with non-steroidal anti-inflammatory medicines or pain killers in the short term.
  • Therapy Treatment: Passive stretching, forward flexion exercises, and crossover arm stretch are a few workouts that help overcome shoulder stiffness. Rest and rehabilitation combined with physical therapy and conservative treatment methods also strengthen the rotator cuff and reduce pain.
  • Surgical Intervention: Surgery is rare for shoulder adhesive capsulitis, and patients treated with shoulder arthroscopy only when the frozen shoulder is extremely painful.
  • Shoulder Manipulation: Forced shoulder movement and stretching is carried out under anesthesia so that the capsule loosens and stiffness is reduced.
  • Minimal Invasive Pain Management Injections

Highly effective and without major side effect, these injections offer long-term relief. Directly administered into the frozen joint, these injections reduce scarring, swelling, inflammation, and pain. This helps in stretching and mobility of the arm while reducing the symptoms fast and substantially.

  • Anesthetic injections – lidocaine that numbs the inflamed area and subdues pain.
  • Corticosteroid injections administer steroid, which eases shoulder capsule contraction/ tightening caused by swelling and inflammation.
  • Glenohumeral joint injections insert anti-inflammatory medication to reduce inflammation and increase mobility of the joint.
  • Hyaluronic acid injections relieve pain and may promote normalization of thickened or contracted or scarred soft tissues around the shoulder joint.

References

Frozen Shoulder, American Academy of Orthopedic Surgeons

Lorbach O, Anagnostakos K, Scherf C, et al; Nonoperative management of adhesive capsulitis of the shoulder: oral cortisone J Shoulder Elbow Surg. 2010 Mar;19(2):172-9. Epub 2009 Oct 1.

Hand GC, Athanasou NA, Matthews T, Carr AJ. The pathology of frozen shoulder. J Bone Joint Surg Br. Jul 2007;89(7):928-32.

Buchbinder R, Green S, Youd JM; Corticosteroid injections for shoulder pain. Cochrane Database Syst Rev. 2003;(1):CD004016.

Tighe CB, Oakley WS Jr. The prevalence of a diabetic condition and adhesive capsulitis of the shoulder. South Med J. Jun 2008;101(6):591-5. [Medline].

American Academy of Orthopaedic Surgeons and American Academy of Pediatrics (2010). Frozen shoulder. In JF Sarwark, ed., Essentials of Musculoskeletal Care, 4th ed., pp. 291–294. Rosemont, IL: American Academy of Orthopaedic Surgeons.

LORI B. SIEGEL, M.D., NORMAN J. COHEN, M.D., and ERIC P. GALL, M.D., Finch University of Health Sciences/Chicago Medical School, North Chicago, Illinois; Adhesive capsulitis: A sticky issue, American Family Physician. 1999 Apr 1;59(7):1843-1850.

Binder AI, Bulgen DY, Hazleman BL, Roberts S. Frozen shoulder: a long-term prospective study. Ann Rheum Dis. Jun 1984;43(3):361-4.

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