Adhesive capsulitis, commonly known as frozen shoulder, is a shoulder condition mainly affecting women between the ages of 35 and 55. This condition causes the shoulder to become rigid and unable to move, with intense pain. It can occur due to severe work or emotional stress or in the presence of specific pathologies.

Adhesive Capsulitis: Where Does it Strike?

Orthopedic specialists in shoulder surgery explain that adhesive capsulitis mainly affects the joint capsule, which is the elastic structure that allows the shoulder to make broad movements. 

Initially, the joint capsule is affected by inflammation (synovitis), degenerating into retracting fibrosis, the same healing process as a burn. In addition, the production of specific cells (fibroblasts and myofibroblasts) is increased, producing fibrous bands that stiffen the shoulder. 

Usually, capsulitis only affects one shoulder, although in 20-30% of cases, it may appear after some time in the other shoulder as well.

Capsulitis manifests itself with continuous and excruciating pain when a sudden movement occurs. Usually, the person cannot lift the arm past the head or reach the upper part of the buttock when trying to touch the back.

Idiopathic Capsulitis

Adhesive capsulitis is idiopathic when it has no known external causes, although constitutional hyperlaxity is a predisposing factor in some cases. 

It is also thought that adhesive capsulitis may be associated with a variety of conditions, such as metabolic diseases (diabetes), thyroid and parathyroid diseases, adrenal diseases, dyslipidemia, neurological diseases, capsular trauma (even mild trauma, such as after pulling a dog, or turning around to pick up your purse from the back seats of a car), and the use of certain medications.

Sometimes capsulitis can appear as a result of fractures (e.g., of the trochis or humeral neck), voiding surgery for calcific tendinitis or partial or complete cuff injury, as well as a consequence of shoulder dislocation, mastectomy, and axillary lymphadenectomy outcomes, or pacemaker implantation.

Orthopedic Examination for Diagnosis

The diagnosis of adhesive capsulitis requires an orthopedic examination with the specialist who, while keeping the scapula locked, observes how and by how much movement is reduced, as well as assessing the intensity of pain felt by the patient. 

The orthopedic examination is also performed with ultrasonography to look inside the shoulder and rule out other pathologies that may cause the pain. Ultrasonography performed during the orthopedic examination also makes it possible to detect any minor trochitis fractures that may be the cause of secondary forms of capsulitis and to check for joint synovitis at an early stage. 

Radiography is also requested to rule out other pathologies such as shoulder arthrosis, calcific tendinopathy, joint fractures, or unknown chronic dislocations.

How is Adhesive Capsulitis Treated?

Adhesive capsulitis is a unique pathology as it can resolve on its own or, in the case of a late diagnosis, the limitation of movement requires arthroscopic surgery

Fortunately, if the condition is recognized early, conservative therapy is curative in almost all cases. This therapy consists of administering low doses of cortisone by oral route (OS) and a course of intra-articular ultrasound infiltration. The use of ultrasound is essential because, in this pathology, the active ingredient must precisely reach its target.