Tennis Injury Prevention: Understanding Frozen Shoulder Syndrome–Adhesive Capsulitis

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Adhesive Capsulitis, or more commonly known as “Frozen Shoulder,” is a condition characterized by pain and stiffness in the shoulder joint. The symptoms typically begin gradually and get worse over time and then slowly improve over the course of many months. It usually has a spontaneous onset of symptoms, caused by the tightening and thickening of the joint capsule surrounding the shoulder. Below, are some of the basics about Frozen Shoulder Syndrome including the anatomy of the shoulder, causes of the condition, and various treatment options.

Anatomy of the shoulder
A ball in socket joint, the shoulder is comprised of the upper arm bone (humerus) and the socket (glenoid). The shoulder capsule is the connective tissue that surrounds the joint, and its function is to keep the joint separate from the rest of the body. It encloses the lubricating joint fluid and keeps the shoulder joint in position and stable.

Causes of Frozen Shoulder
Frozen Shoulder is a condition where the joint capsule and surrounding tissue of the Shoulder Joint becomes inflamed and then thickens making the shoulder painful and stiff. It should also be noted that many cases of Frozen Shoulder have no clear cause and occurs spontaneously.

►​Acute injury: This refers to any trauma or pain that prevents one from moving their shoulder. Usually in Adhesive Capsulitis, a minor trauma instigates the start of the disorder.

►Endocrine Disorders: Thyroid disease and diabetes are associated with Adhesive Capsulitis. This is likely due to the fact that these are auto-immune disorders, disorders where there is immune system over activity, and the body attacks and damages its own tissues.

►Gender: Women generally have a higher rate of Adhesive Capsulitis than men.

Treatment Options
Oftentimes, Frozen Shoulder Syndrome will resolve on its own after going through three stages.

1. Freezing: The progression of pain. During this phase, the joint capsule is just starting to become inflamed. The shoulder is painful, but joint stiffness is not severe.

2. Frozen: Motion limitations due to pain and stiffness. During this phase, the joint capsule is inflamed and the shoulder tends to get stiffer and stiffer over time. In this phase, due to inflammation, the shoulder hurts constantly.

3. Thawing: In this phase, the inflammation has resolved so pain is minimal at the point of rest. The capsule though is still stiff and thickened, so motion is limited and pain occurs at the end ranges of motion or with quick movements. During this phase, motion slowly improves usually until back to normal.

In most cases, Frozen Shoulder is treated non-surgically with physical therapy exercises and cortisone injections. Cortisone injections work best in the early period of the disease to stop the inflammation prior to shoulder becoming significantly stiff. Physical therapy and home stretching stretches out the capsule to regain motion. If this treatment is not effective, a surgical procedure, known as Capsular Release, may be recommended. Most with Adhesive Capsulitis treated conservatively will regain their motion and never need a surgical procedure for this problem.