Dr. Ebraheim’s educational animated video describes the condition of frozen shoulder - adhesive capsulitis.
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Adhesive Capsulitis (Frozen Shoulder)
Frozen shoulder is a condition where the shoulder does not move normally. Frozen shoulder is a disorder of the shoulder joint capsule, and it is also known as adhesive capsulitis. In this condition, the patient is unable to move the arm up or turn it to the side (usually there is loss of external rotation of the shoulder). The condition is painful. It occurs due to thickening and tightening of the shoulder capsule and ligaments, especially the coracohumeral ligament. Frozen shoulder can occur by itself or following trauma, even from minor trauma. It can also follow surgery. The process of frozen shoulder usually begins with pain. The pain is severe, especially with movement, and the patient is usually unable to sleep. The patient will be unable to move the shoulder from the pain, and the condition will lead to stiffness of the shoulder. Frozen shoulder may take a long time to resolve, perhaps even several years. The condition of frozen shoulder occurs more in diabetics, especially those who are insulin dependent, and the condition is more severe in diabetics. It can also occur in patients with dupuytren contracture and hypothyroidism. Frozen shoulder tends to occur more in females, especially in their fourth decade of life. Examine the patient’s range of motion both actively and passively. Active range of motion means to ask the patient to move the shoulder. Passive range of motion means the examiner will try to move the shoulder. In adhesive capsulitis, there is decreased range of motion both actively and passively. Try to differentiate the shoulder movement from scapulothoracic movement. Examine the other shoulder because the risk is high for the other shoulder to also become frozen. Exclude dislocation of the shoulder, especially posterior dislocation. With posterior dislocation, the patient will have limited external rotation, the same as adhesive capsulitis. Obtain an axillary view x-ray to differentiate between the two conditions. In posterior dislocation of the shoulder, the humeral head will dislocate posteriorly. In frozen shoulder, the humeral head will remain in its normal location. Not every frozen shoulder is adhesive capsulitis. Please exclude dislocation, diabetes, infection, fractures, and tumors (all these conditions can cause frozen shoulder or limitation of the shoulder range of motion). Treatment is usually complex. Do early aggressive uninterrupted, continuous physiotherapy, pain control, and shoulder injection and manipulation. Surgery is sometimes helpful to release the contractures and adhesions.
