| The shoulder capsule contains ligaments that attach the shoulder bones to each other. When inflammation occurs in the capsule, the shoulder bones cannot move well. Adhesive (scarred) capsulitis (inflamed joint capsule) can causes stiffness, loss of motion, and often excruciating pain. The condition occurs more frequently in middle-aged women (ages 40 - 70) than in men. It appears that people at the greatest risk are patients with diabetes, or those who've had a shoulder injury or surgery, open heart surgery, hyperthyroidism, or cervical disk disease. It is not related to arthritis. The pain progresses and results in loss of motion in the shoulder since the affected person tries to avoid the pain by moving the shoulder and arm less. The loss of ability to raise and rotate the arm restricts simple daily activities such as dressing or hair styling. The pain may be so intense that it prevents sleep. There is some discussion in some of the articles I read about different stages such as the freezing stage, the frozen stage, and the thawing stage. Personally I could not relate to these stages. Others may have different experiences. Links to articles are provided on the left-hand side of this page. The usual treatment consists of intense physical therapy and the use of anti-inflammatory medication by mouth or injections. Many patients improve with these treatments but it may take several months and the patient must continue stretching and strengthening exercises at home. Dr. Berstein advocates using deep trigger-point massage, which he explains as follows. "Tender trigger points can be found in the supraspinatus, infraspinatus, teres major/minor, deltoid and trapezius muscles – usually at insertions of tendon into bone. Other trigger points can be found in the joint capsule and the biceps tendon. These trigger points are usually tender spots that feel like knots to the palpating finger. Deep trigger point massage by a competent physiotherapist inevitably cures the condition. The catch again is that symptoms will return if blood sugars are not kept meticulously controlled." For the more stubborn cases, a surgical procedure may be performed. The most common processes are shoulder manipulation and/or arthroscopy. The manipulation is done under anesthesia and involves bending and stretching the arm to break loose any adhesions. Care must be taken to avoid breaking the arm. With the arthroscopy small incisions are made to insert a small camera and instruments. The instruments cut through the tight portions of the joint capsule. Frequently manipulation and arthroscopy are used together, using the manipulation to loosen the arm, then the arthroscopy to clean the sticky residue. After surgery it is of the utmost importance to start several weeks of intense physical therapy immediately, otherwise the freezing will start again. Recovery time may vary depending on the patient's occupation and speed of recovery. The cause of the inflammation that results in adhesive capsulitis is unknown. The condition develops slowly and in stages. Further research is needed to determine which treatments work best, or if treatment actually changes the normal course of the condition. |
| My Own Experiences with Adhesive Capsulitis |
It was the end of January in the year 2001; I had just finished getting out all the W2's and 1099's and then took the supplies downstairs to the storage room to put them away for next year. I put a box of envelopes weighing possibly one or two pounds onto a shelf above my head, then gave it a shove with my left hand to get it farther back onto the shelf. The act of drawing back my arm and pushing it forward gave me the most painful experience I could ever remember. The pain absolutely paralyzed me; I could not move at all. I thought I would have to call out to someone to help me. After a couple of minutes or so, the pain started to subside and within another five minutes I was fine. It seemed like such a freak thing; I had no idea what was wrong. I have a very demanding job and this was my busy time of year so the event was soon pushed to the back of my mind. The next time I had a similar event was in July, over five months later. I had gone to a particular business for the first time; when I came out of the building, I encountered an unexpected step down. In order to balance myself to avoid falling, I threw my arms back. Here we go again; excruciating pain! I saw stars! As I stood very still, I considered asking one of the passers-by to call an ambulance. I am not a stranger to pain and I am not spineless; on a scale of 1 to 10, this was a definite 10! However as before, after perhaps two or three minutes, the pain started to slip away. After this episode, I concluded that I needed to be careful about how I moved my arm. As the next few months went by, I noted a soreness but I avoided the same kind of motion that had given me so much pain before. I wondered if I had somehow damaged a tendon. Then it happened again. This time (November) I had gone into the city (Chicago) by train. I held onto the railing with my left hand as I walked down the steps from the rail car. From the bottom step I jumped onto the pavement below with my hand still on the railing. This action gave my arm and shoulder a slight pull. I was ready to cry, but experience had taught me that if I just waited, the pain would go away. I rarely thought about this problem because during this entire year, the only time it bothered me were these three instances. A few weeks later I saw my family practice doctor with some other problem and mentioned the arm/shoulder pain. He advised me to see the orthopaedic surgeon that had treated my knee. Saw the orthopaedic doctor in Feb. 2002; an exam showed that my range of motion had decreased and that certain motions caused pain. An MRI showed that I had some inflammation in the shoulder joint and impingement in both shoulders. An impingement means that the bones in the shoulder are not perfectly aligned which can cause some pain, however in retrospect I do not think this was the cause of any of my pain at all. On the second visit, the doctor gave me a cortisone injection which hurt almost as much as the problem because of the "mile-long" needle. My shoulder was sore from the injection for several days; I don't think it did any good at all. He also gave me an order for 12 weeks of therapy, 3 times a week. The therapy was painful and always left my arm and shoulder sore and hurting; it may have helped the movement some, but if I happened to move my arm that certain way, I still experienced excruciating pain. During my time of therapy I also began taking the anti-inflammatory drug Celebrex. I determined that I could probably live with the condition as long as I was very careful not to move it very much. The only problem with that theory was that in the course of going through multiple daily activities, there were many occasions when the arm was moved in a way that caused that horrible hurting. As I went through the rest of 2002, then 2003, and into 2004, my ailment gradually became worse. I read about frozen shoulder on the online diabetes support group lists that I had joined. Summer of 2004 was the point when I decided that something else had to be done. It hurt whether I moved it or not, many times with a throbbing pain. It prevented me from sleeping and I had a difficult time performing my job. I could hardly function. The orthopaedic surgeon I had seen before no longer had an office near my home. His main office was farther away than I cared to drive so I began a search for a new orthopaedic doctor. After finding one, I went in for an appointment and he recommended performing the surgical manipulation. I had this done in mid Nov. 2004; the surgeon told me later that as soon as he started bending and pushing on my arm, he could hear the "pop, pop, pop" of adhesions breaking loose. I experienced tremendous relief from the lack of intense pain and a greatly improved range of motion almost immediately. Right away I started a four week program of forceful physical therapy. Yes it was still tender with some pain but almost nothing compared to what I had before. After the month of therapy my range of motion is nearly 100% and the pain is practically gone. I still need to continue the exercises at home to regain strength and to get to the 100% motion range. I have read and I've heard some people say that adhesive capsulitis lasts about two years. However I suffered with it for almost four years and probably would be still if my doctor hadn't treated with the surgical manipulation. If I had known about this procedure and what a difference it would make, I would have had it done a lot sooner. |
| Important! Your experience may be different. If you suffer from this condition, you need to seek treatment and advice from your own personal physician. |
http://www.faqs.org/faqs/diabetes/faq/part3/ section-22.html This article contains some good information but I have to disagree with some of the faqs such as "the condition lasts two years with or without treatment" and the statement that surgical procedures should be avoided since the patient has to do the exercises anyway. I contended with this problem for almost four years; it grew progressively worse. It was only after the surgical procedure that I had a tremendous relief. Yes I had therapy afterward but the adhesions had to be broken loose first. |
| This picture is from Dr. Cluett's article referenced in top section. |
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Adhesive capsulitis, also known as frozen shoulder, affects many diabetics. It seems that so little is known about the condition and not much information is available, so I decided it would be worthwhile to make a separate webpage summarizing what I've found and telling about my experience. This material is not intended to replace the medical advice from your physician. It is given for informational purposes only. |
| Adhesive Capsulitis or Frozen Shoulder |
| Links to References Used : |
| These figures are from the article by Johns Hopkins Sports Medicine. |
