Understanding adhesive capsulitis (frozen shoulder) and how to treat it

Understanding what frozen shoulder is, also known as adhesive capsulitis, is the first step to addressing this condition that limits movement and causes pain. This condition affects the capsule surrounding the shoulder joint, making it thicker and stiffer. Throughout this article, we will explore in detail what happens in the joint, the factors that increase the risk of suffering from it, how it manifests, and, most importantly, the different ways we can treat it to regain functionality.

Key Points about Frozen Shoulder

• Frozen shoulder, or adhesive capsulitis, is characterized by the thickening and stiffness of the shoulder joint capsule, which causes pain and a marked limitation of movement.

• This condition usually occurs in people between 45 and 60 years old, being more common in women, and may be associated with other medical conditions such as diabetes or thyroid problems.

• The evolution of frozen shoulder is typically divided into three phases: the freezing (painful), the frozen (adhesive and stiff), and the thawing (recovery) phase, with the entire process potentially lasting up to two years.

• Diagnosis is based primarily on medical history and physical examination, although imaging tests are sometimes used to rule out other shoulder pathologies.

• Treatment for frozen shoulder focuses on relieving pain and restoring mobility, combining pain management (medications, ice), physical therapy with specific exercises, and, in some cases, procedures such as manipulation under anesthesia.

Understanding Adhesive Capsulitis

Adhesive capsulitis, commonly known as "frozen shoulder," is a condition that affects the shoulder joint capsule. This capsule is a kind of soft tissue envelope that surrounds the joint, allowing its natural movement. In the case of frozen shoulder, this capsule becomes thicker and more fibrous, which significantly restricts mobility.

Definition of Frozen Shoulder

Frozen shoulder is characterized by inflammation and subsequent thickening and hardening of the joint capsule. This process leads to the formation of adhesions, which are like "sticky patches" of tissue that limit the joint's ability to move freely. The main result is persistent pain and a marked limitation in the shoulder's range of motion.

Anatomy of the Shoulder Joint

The shoulder joint is a marvel of biological engineering, designed to offer exceptional range of motion. It is composed of the head of the humerus (the arm bone), the scapula (shoulder blade), and the clavicle. The great mobility it provides also makes it a relatively unstable joint, but this instability is compensated by powerful musculature and the aforementioned joint capsule, which helps keep everything in place and lubricate the joint.

Alterations of the Joint Capsule

In adhesive capsulitis, the joint capsule undergoes significant changes. An inflammatory process begins which, over time, leads to fibrosis, that is, the deposition of scar tissue. This tissue is less elastic than normal capsular tissue. The thickening and stiffness are especially noticeable in the lower part of the capsule. Although the exact cause is not always clear, it is believed that there is a significant inflammatory component, and in some cases, autoimmune or systemic factors may be involved. People with certain medical conditions, such as thyroid problems or diabetes, have a higher propensity to develop this condition. If you suspect you may be suffering from frozen shoulder, it is advisable to consult with Dr. Santiago Manzanal for a proper evaluation.

Risk Factors and Affected Population

Predominant Age and Gender

Adhesive capsulitis, or frozen shoulder, tends to affect middle-aged individuals more frequently. Generally, it is observed in people between 40 and 60 years old. While it can occur in other age groups, this range is the most susceptible. Regarding gender, women are usually diagnosed more frequently than men, although the exact reasons for this difference are not completely clear.

Associated Medical Conditions

Certain medical conditions increase the likelihood of developing frozen shoulder. People with diabetes, for example, have a significantly higher risk. Diabetes can alter collagen metabolism, which could make the joint capsule more prone to inflammation and stiffness. Other conditions that have been linked include:

• Thyroid diseases (both hypothyroidism and hyperthyroidism).

• Cardiovascular diseases.

• Parkinson's disease.

• Cerebrovascular accidents (strokes).

These systemic conditions can influence the body's inflammatory response and the general health of connective tissues.

History of Trauma or Surgeries

A history of shoulder injuries, such as fractures or dislocations, can be a precursor to frozen shoulder. Similarly, having undergone shoulder surgery, even if successful, can increase the risk. Prolonged immobilization after an injury or surgery, necessary for healing, can sometimes lead to joint stiffness if not managed properly with early rehabilitation. It is important that, after any such event, a rehabilitation plan supervised by professionals like Dr. Santiago Manzanal is followed to minimize future complications.

Clinical Manifestations of Frozen Shoulder

Adhesive capsulitis, commonly known as frozen shoulder, is primarily characterized by two symptoms that significantly impact daily life: pain and stiffness.

Main Symptoms: Pain and Stiffness

The pain is usually dull and constant, often worsening at night. This nocturnal discomfort can interrupt sleep and generate a continuous feeling of unease. Stiffness manifests as a progressive limitation in moving the arm in any direction. Initially, it may be a minor inconvenience, but over time, it makes daily activities such as combing hair, buttoning clothes, or reaching for objects difficult.

Limitation of Range of Motion

One of the most evident signs of frozen shoulder is the marked decrease in range of motion, both active (when you move your arm) and passive (when someone else moves your arm). This limitation affects all directions: elevation, internal and external rotation, and abduction. It is important to differentiate this condition from other shoulder pathologies, such as rotator cuff injuries, so a professional evaluation is key. If you suspect you may have frozen shoulder, consulting with Dr. Santiago Manzanal can be an important step for an accurate diagnosis.

Patterns of Night Pain

Night pain is a distinctive feature of adhesive capsulitis. Many people experience increased pain when lying down, especially if they sleep on the affected side or if the arm is in an uncomfortable position. This persistent pain during the night can be particularly frustrating and aggravate the feeling of stiffness upon waking. Managing this pain is a primary goal in the early stages of the disease, and Dr. Santiago Manzanal can guide you on the best strategies to relieve it.

The evolution of frozen shoulder is typically divided into three phases: the freezing (painful), the frozen (adhesive), and the thawing (recovery) phase. Each phase presents distinct symptoms and challenges that require adapted treatment approaches.

Phase	Approximate Duration	Main Characteristics
Freezing	6-9 weeks	Increased pain, onset of stiffness, limitation of movement
Frozen (Adhesive)	4-6 months	Pain decreases, severe stiffness, maximum functional difficulty
Thawing	6 months - 2 years	Stiffness gradually decreases, slow recovery of movement

Full recovery can be a long process, and patience is essential. For those seeking a more advanced solution, such as a reverse total shoulder replacement, it is essential to discuss all options with a specialist.

Evolution by Phases of the Pathology

Adhesive capsulitis, commonly known as frozen shoulder, does not appear suddenly. It usually progresses through distinct stages, each with its own characteristics and challenges. Understanding these phases is key for effective management and to know what to expect during the recovery process. Dr. Santiago Manzanal explains that the typical course of this condition is divided into three main phases:

Freezing or Painful Stage

This is the initial phase and is primarily characterized by pain. The pain can be quite intense, even at rest, and often worsens at night, interrupting sleep. Shoulder mobility begins to decrease significantly during this period. Daily activities that require lifting the arm or reaching for objects become difficult and painful. This stage can last between 3 and 9 months.

Frozen or Adhesive Stage

Once the acute pain phase is over, the shoulder enters the frozen stage. Here, the pain tends to decrease, but stiffness becomes the predominant symptom. The range of motion is severely limited, making simple tasks like combing hair or buttoning clothes a real challenge. The shoulder feels "stuck" or "frozen." This phase can last between 3 and 6 months.

Thawing or Recovery Stage

The last stage is the thawing stage, where shoulder mobility gradually begins to recover. Pain is minimal or nonexistent, and the range of motion slowly improves. The duration of this phase is highly variable, but over time, most people regain nearly normal shoulder function. The entire process, from the onset of the first symptoms to recovery, can last up to 24 months. It is important to be patient and consistent with the treatment recommended by Dr. Santiago Manzanal during this phase to optimize recovery.

Diagnostic Process for Frozen Shoulder

Correctly identifying frozen shoulder is the first step to effective treatment. Dr. Santiago Manzanal focuses on a detailed evaluation to reach an accurate diagnosis.

Clinical Evaluation and Physical Examination

The basis of diagnosis lies in a detailed conversation about your symptoms and a thorough physical examination. You will be asked to move your arm in different directions: up, forward, sideways, and backward. Difficulty or pain when performing these movements are key indicators.

• Movements evaluated:Arm elevation (anterior flexion).Abduction (moving the arm away from the body).External and internal rotation.

• Special attention is paid to the limitation of range of motion, both active (when you move your arm) and passive (when the doctor moves your arm).

Differential Diagnosis with Other Pathologies

It is important to distinguish frozen shoulder from other conditions that can cause shoulder pain and stiffness, such as rotator cuff problems or arthritis. A careful evaluation helps rule out these other possibilities.

• Conditions to rule out:Rotator cuff tendinopathy.Labral tears.Glenohumeral arthritis.Calcifications.

Use of Complementary Imaging Tests

Although the diagnosis is usually clinical, imaging tests are sometimes used to confirm or rule out other causes of pain. X-rays can show signs of osteoarthritis or calcifications, while a magnetic resonance imaging (MRI) can be useful to visualize the condition of the tendons and joint capsule, helping to differentiate from injuries such as distal biceps avulsions.

Medical history and physical examination are the most important tools for diagnosing frozen shoulder. Imaging tests are primarily used to rule out other pathologies that may be causing similar symptoms.

If you experience shoulder pain and stiffness, consult with Dr. Santiago Manzanal for a proper evaluation.

Treatment Strategies for Frozen Shoulder

Addressing adhesive capsulitis, or frozen shoulder, requires a multifaceted approach tailored to the specific phase of the pathology. The main goal is to relieve pain, restore range of motion, and improve overall shoulder function. It is important to consult with a healthcare professional, such as Dr. Santiago Manzanal, for a personalized diagnosis and treatment plan.

Pain and Inflammation Management

In the initial stages, when pain is the predominant symptom, management focuses on reducing inflammation and discomfort. This may include:

• Medications: Over-the-counter or prescription non-steroidal anti-inflammatory drugs (NSAIDs) can be helpful. Always consult your doctor or pharmacist before taking any medication.

• Cold Therapy: Applying ice to the affected area for 15-20 minutes several times a day can help reduce inflammation and pain.

• Electrotherapy: Techniques such as TENS (Transcutaneous Electrical Nerve Stimulation) can offer pain relief.

Pain control is essential to allow active participation in physical therapy and prevent the progression of stiffness.

Physical Therapy and Therapeutic Exercises

Physical therapy is a cornerstone in the treatment of frozen shoulder, especially in the freezing and thawing phases. Goals include improving mobility, strengthening muscles, and restoring function.

• Manual Mobilizations: The physical therapist performs gentle, controlled movements of the shoulder joint to stretch the joint capsule and break adhesions. These movements can be uncomfortable and are performed carefully so as not to exacerbate the pain.

• Stretches: Specific stretching exercises are prescribed to gradually increase the range of motion in all directions (flexion, abduction, internal and external rotation). It is common for these stretches to be performed to the point of resistance, which can cause discomfort.

• Pendulum Exercises: Gentle, relaxed arm movements, allowing gravity to help mobilize the joint.

• Strengthening: Once pain and stiffness decrease, exercises are introduced to strengthen the rotator cuff muscles and scapular musculature, improving shoulder stability and control.

• Additional Techniques: May include thermotherapy (heat) before exercises to relax muscles, gentle massages, and myofascial release techniques.

Surgical Options and Manipulations

When conservative treatment does not produce the expected results, or in cases of severe stiffness, more invasive options may be considered.

• Manipulation Under Anesthesia (MUA): Under general anesthesia, the doctor moves the shoulder in different directions to stretch and break the adhesions of the joint capsule. This procedure aims to recover range of motion more quickly but requires an intensive post-procedure rehabilitation program.

• Arthroscopy: In some cases, arthroscopic surgery can be performed to release the thickened capsule and remove adhesions. After surgery, physical therapy is essential to maintain and improve the gained mobility.

The choice of the most appropriate treatment will depend on the individualized evaluation by Dr. Santiago Manzanal, considering the stage of the disease, the intensity of symptoms, and the patient's response to conservative therapies.

If your shoulder feels stiff and hurts when you move it, you might have frozen shoulder. There are several ways to treat it so you can move your arm freely again. Do you want to know what the best options are for you? Visit our website to discover more.

In Summary: Regaining Your Shoulder Mobility

Understanding adhesive capsulitis, or frozen shoulder, is the first step to managing it. Although it can be a frustrating and painful condition, often progressing through distinct stages of freezing, stiffness, and eventual recovery, there are clear paths to improvement. Treatment, which usually combines pain management with anti-inflammatories and ice, along with consistent physical therapy adapted to each phase, is key. Mobility and stretching exercises, guided by a professional, are fundamental to regaining range of motion. While the process can be long, sometimes up to two years, patience and adherence to the treatment plan usually yield good results, allowing a return to daily activities with greater comfort.

Frequently Asked Questions about Frozen Shoulder

What exactly is frozen shoulder and why does it occur?

Frozen shoulder, also called adhesive capsulitis, is a condition where the covering of the shoulder joint becomes thick and tight. This makes it very difficult to move the shoulder. It's still not known exactly why it happens, but sometimes it appears after an injury or surgery, or in people with certain diseases like diabetes.

What are the most common symptoms of frozen shoulder?

The main symptoms are pain that worsens at night and great difficulty moving the shoulder. At first, pain is the most bothersome, but then stiffness becomes the main problem, making simple tasks like combing hair or buttoning clothes almost impossible.

In what phases does frozen shoulder evolve?

This condition usually goes through three stages. First, the 'freezing' stage, where pain increases and movement begins to be limited. Then, the 'frozen' stage, where pain may decrease a bit, but stiffness is at its maximum. Finally, the 'thawing' stage, where movement gradually returns, although it can take a long time.

Who is more prone to suffering from frozen shoulder?

Generally, it affects people between 40 and 60 years old more, and it is more common in women. There is also a higher risk if you have diabetes, thyroid problems, or if you have had an injury or surgery on your shoulder that required immobilization for a period.

How is frozen shoulder diagnosed?

The doctor usually diagnoses it by asking about your symptoms and checking how you move your shoulder. They will ask you to perform certain movements to see how limited it is. Sometimes, they may order an X-ray or an MRI to rule out other shoulder problems.

What treatments exist for frozen shoulder?

The main treatment includes pain relief with medication and applying cold or heat. Physical therapy is very important, with exercises to regain movement and strength. In some cases, if the pain or stiffness is very severe and does not improve, manipulation under anesthesia or surgery to release the shoulder capsule may be considered.