Dr. Nicholas Cappello

I am still waiting for the Cause and Cure  for this painful condition and I hope we are getting close. Your Doc will call it Adhesive capsulitis, is an almost a complete limitation in shoulder motion in which active and passive range of motion are restricted. In the absence of a known shoulder disorder, the condition is referred to as idiopathic adhesive capsulitis…

There is a loss of shoulder joint volume and the shoulder joint lining synovium has marked changes. The characteristics and process have been well documented over the past half century but the optimal treatment remains vague

Although the cause of adhesive capsulitis remains largely unknown, it is likely the result of a few factors… Associated factors include female (women are affected more than twice as often as men), age > 40 years, prolonged immobilization, diabetes, trauma, thyroid disease, stroke, myocardial infarction, autoimmune disease, and prior adhesive capsulitis (20% to 30% of patients develop opposite-side adhesive capsulitis). The cause involves an inflammatory and fibrosing process, which is highly dependent on the stage of the disease.  The pathology of adhesive capsulitis includes a chronic inflammatory response with fibroblastic proliferation that may be auto immune in origin. My explanation to patients is the body thinks the shoulder joint belongs to someone else and is attempting  to prevent it from doing harm to it.

History and Physical Examination

As with most medical conditions, the key to diagnosis is a patient’s history and physical examination. Location and type of pain typically include a deep diffuse aching pain. Non specific sharp stabbing or burning pain may occur at the onset of motion. Night pain, like a deep, throbbing toothache-like pain, may wake the patient from sleep or cause difficulty starting to sleep. Onset of pain often precedes loss of motion. . Neck pain can result from the shoulder tiring to use other muscles and joints to compensate. Scapular dysfunction or compensation for glenohumeral stiffness. There are other conditions that resemble frozen shoulder…

Usually the easiest finding is loss of external rotation at the side, compared to the normal shoulder. Pain on touching the front of the shoulder is common. is I often will inject xylocaine and see if the joint will move to rule out the other conditions While Codman¹ described frozen shoulder as a benign, self-limiting process with all cases resolving within 2 years, further studies reveal that resolution can take significantly longer and that some patients continue to experience restricted motion and pain.

Nonoperative Treatment

Nonoperative treatment is most effective if initiated early in the course of adhesive capsulitis, before fibrosis begins. The mainstay includes a physical therapy program designed to decrease pain and improve range of motion. Therapy begins with passive stretch at end range of motion and should include a frequent home stretching program. Isometrics are allowed early, but strengthening should with withhold until full painless passive range of motion is achieved. Oral nonsteroidal anti-inflammatory medication and intra-particular steroids minimize inflammation and are useful for pain control…

Overall, patients are satisfied after a stretching-exercise program at 2-year follow-up. However, many patients still have some residual pain and motion limitation compared to their unaffected,  shoulder.

Operative Treatment

Operative treatment includes manipulation under anaesthesia +/- arthroscopic release. Open capsular release has lost favour because of an increased risk of loss of motion and. Surgeons can perform gentle manipulation followed by arthroscopy, or distention of the joint with saline followed by arthroscopy and then manipulation. Releasing the rotator interval first will have a profound effect on increasing the glenohumeral joint volume.

Conclusions

Non-operative management should be attempted as primary treatment in all patients and is successful in most. Surgical treatment is most effective after waiting  at least 6 months to a  year.   Advantages of an arthroscopic release are numerous: it allows for controlled capsular release; compared to a manipulation alone, manipulation after an arthroscopic release requires less force; a synovectomy and treatment of concomitant pathology can be performed; better results in diabetic patients than physical therapy alone;

Duke Sports Medicine experts Randall Lazicki, and Shefali Christopher talk about how essential it is to build your “core muscles”, or “muscle core” for a strong and healthy body along with living a healthly lifestyle.  In this video they teach a particular exercise called “Table Top” that helps to strengthen the body core muscles

Please follow these easy steps to properly execute the this exercise:

1.  Position body on hands and knees, shoulders overhand and hips over your knees.

2.  Pull your belly button toward your spine a few times to active your core muscles

3.  While doing step 2, you can slowly life your arms and legs in rythm to further exercise your core muscles

4.  Alternate arms and legs while exercising your core muscles.

5.  Keep core muscles contracted so there is minimal movement in the lower back area

Shefali  also provides and anatomy lesson on the core muscles and core region of the body.  This exercise is does not treat any current condition, but it is meant to help you build a strong an healthy core to help you improve your lifestyle.