Adhesive Capsulitis / Frozen Shoulder
The shoulder is the most mobile joint in the body. It consists of a ball known as the humeral head (the top part of the arm bone) and a socket known as the glenoid (a part of the shoulder blade). Strong, flexible connective tissue surrounds the joint, and is known as the shoulder capsule. In some patients, this capsule can become very thickened and inflamed, significantly limiting motion and causing substantial pain.
Patients with adhesive capsulitis describe stiffness and pain in the shoulder. This causes difficulty with daily activities, pain while reaching for objects, and may even interfere with sleep at night. Patients with diseases such as diabetes or hypothyroidism are particularly susceptible to developing adhesive capsulitis.
In most cases, adhesive capsulitis can be successfully treated without surgery. A combination of a corticosteroid (cortisone) injection into the shoulder joint and a course of physical therapy to restore range of motion is successful in 80-90% of patients. If the adhesive capsulitis persists despite this treatment, surgery may be necessary to release the thickened joint capsule. This is an outpatient surgery which is performed arthroscopically in a minimally-invasive fashion. After anesthesia is given, two to three to small incisions (under ¼" each) are made around the shoulder. A camera (arthroscope) is placed in the shoulder joint and using special instruments, the capsule is evaluated and released. The shoulder is taken through range of motion to ensure that full mobility has been restored.
After surgery, the patient is placed in a sling overnight, and then physical therapy is begun the following day. Physical therapy is used to maintain the range of motion gained by releasing the capsule, and prevent scar tissue from accumulating and limiting shoulder motion.
Further information about adhesive capsulitis can be found in this AAOS OrthoInfo article.