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Adhesive Capsulitis
Tyler Sanders
Pensacola State College
Adhesive capsulitis, also known as frozen shoulder, is a condition associated with
shoulder pain and stiffness. When diagnosed with frozen shoulder there is a loss of mobility in
the shoulder that creates a deficit in the shoulder joints full range of motion. The onset for frozen
shoulder is gradual and can develop anywhere from a few weeks to months. Due to the lack of
mobility in the shoulder muscle loss around the shoulder is common.
Frozen shoulder occurs when the bones, ligaments, and tendons that make up the
shoulder joint thicken and tighten restricting its movement. There is no definite etiology made
for frozen shoulder, but diabetes and long periods of shoulder immobilization may increase the
likelihood of developing this condition. An article from the Mayo Clinic says, “Doctors aren't
sure why this happens to some people, although it's more likely to occur in people who have
diabetes or those who recently had to immobilize their shoulder for a long period, such as after
surgery or an arm fracture.” (Mayo Clinic, 2020). As mentioned earlier, frozen shoulder develops
gradually, and in stages. First is the Freezing stage which is when the onset of pain and lack of
range of motion develops. Second comes the frozen stage in which pain may decrease, yet the
shoulder becomes stiffer. Finally, is the Thawing stage which is when function in the shoulder
begins to come back.
Diagnosis for frozen shoulder can come from signs and symptoms alone, although
there are certain cases where doctors can suggest an imaging test. An X-Ray or MRI can be
helpful in ruling out other possible problems. The incidence rate for frozen shoulder is low
overall, although it is much higher for those with diabetes. An article on adhesive capsulitis
reports, “The incidence of adhesive capsulitis in the general population is approximately 3% to
5% but as high as 20% in patients with diabetes.” (Department of Orthopedic Surgery, 2016). As
mentioned earlier, frozen shoulder is most common in those who have diabetes, or those who
have recently had a surgery in which shoulder mobility would be limited for a long period of
time.
Those who have been diagnosed with frozen shoulder will most likely choose
physical therapy for a treatment option. Physical therapist can help treat frozen shoulder by using
interventions such as stretching, modalities, and therapeutic activities to help decrease pain and
increase range of motion in the shoulder. The recovery process for frozen shoulder has been
described as even more painful than the beginning stages of the condition. The reason for the
recovery process being so painful is because it requires exercises and stretches that push the
patients range of motion to their limits which can be very painful. In most cases, skilled care
rehabilitation is only required early in the recovery process with most of the exercises being
manageable independently. All exercises provided by a physical therapist have a common goal of
increasing function in the shoulder by providing exercises that increase shoulder mobility.
Performing interventions that focus on increasing mobility and strength are most
important recovery from the condition. In the book Clinical Anatomy and Kinesiology, Lippert
says, “When pathology such as capsular tightness interferes with joint motion, use of
arthrokinematics motion can assist in restoring that motion by stretching the joint capsule.”
(Lippert, 147). It is important to warmup before performing any exercises. The pendulum stretch
is an exercise used to warm up the shoulder joint; it is performed by leaning over slightly
allowing the affected arm to hang, and with the arm relaxed swing the arm in circles performing
a set number of resolutions in both directions. Once the shoulder is warmed up, therapeutic
exercises such as stretching can be used. An example of an exercise that would be appropriate for
rehab would be the cross-body stretch. In the cross body stretch the affected arm would be lifted
and held by the non-affected arm across the body. While holding the stretch the nonaffected arm
will provide gentle pressure onto the affected arm providing a stretch in the joint. As mentioned
before, the recovery process can be painful but stretching the shoulder is necessary to promote to
goal of increased range of motion.
With the shoulder being the axis for all arm movement, it is expected that any
injury to the shoulder would heavily impact activities of daily living. Stiffness in the joint will
progressively become worse without arthrokinematics motions. Mobility exercises are the main
intervention that will benefit frozen shoulder and make a positive impact in recovery.
References
Mayo Foundation for Medical Education and Research. (2020, August 1). Frozen Shoulder.
Mayo Clinic. Retrieved October 17, 2021, from https://www.mayoclinic.org/diseasesconditions/frozen-shoulder/symptoms-causes/syc-20372684.
Le, H. V., Lee, S. J., Nazarian, A., & Rodriguez, E. K. (2017, April). Adhesive capsulitis of the
shoulder: Review of pathophysiology and current clinical treatments. Shoulder & elbow.
Retrieved October 17, 2021, from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5384535/.
Lippert, L., D., M. M. A., Towler, C. D., & Minor, S. D. (2023). Clinical kinesiology and
anatomy. F.A. Davis Company.
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