In a shoulder with adhesive capsulitis, the joint capsule becomes thickened and inflamed. During arthroscopic surgery, the affected capsule can have the appearance of the below image on the right (compared to normal tissue in the image on the left):

Symptoms of Adhesive Capsulitis / Frozen Shoulder

Frozen shoulder can occur spontaneously, or after any type of injury to the shoulder. Patients often report onset of frozen shoulder after even very minor shoulder injuries or strains, such as lifting something heavy or reaching in the backseat of their car. Frozen shoulder can also occur after shoulder surgery or any period of immobilization.

There are a number of demographic and medical factors that have been associated with the development of frozen shoulder. It more commonly occurs in women between the age of 40 to 60, often coinciding around the time of menopause, but it can happen to people of all ages and to men as well. It is also associated with endocrinological conditions such as diabetes and thyroid disorders. Still, many cases are considered idiopathic (of unknown or no particular cause).

Frozen shoulder is described as generally consisting of three phases - the freezing/inflammatory phase, the frozen/stiff phase, and finally the thawing phase. It is almost always a self-limiting disease, or in other words, frozen shoulder does get better on its own over time. However, this process of resolution can take a very long time - sometimes years! For that reason, we often recommend various forms of treatment that may expedite the recovery process.

Non-Surgical Treatment of Adhesive Capsulitis / Frozen Shoulder

Non-surgical treatment is generally very successful at expediting the process of recovering from a frozen shoulder. The most important component of this is diligent supervised physical therapy with an emphasis on gentle, progressive shoulder stretching. The therapist can also add various modalities such as heat and cryotherapy to the stretching program.

Managing shoulder inflammation and pain is also important to successful non-surgical treatment of frozen shoulder (reducing pain can allow for more diligent and aggressive physical therapy). This can be achieved through oral anti-inflammatory medications (i.e. ibuprofen, naproxen, meloxicam, etc.) or a cortisone injection.

Surgical Treatment

If non-surgical treatment is unsuccessful at restoring shoulder range of motion and function, then surgical treatment may be an option. The procedure would consist of shoulder arthroscopic capsular release, performed in a minimally-invasive fashion. Any other concurrent issues in the shoulder would be addressed at the time of surgery as well. During the surgery, the thickened contracted capsule around the shoulder joint is released, and a gentle manipulation under anesthesia is performed to restore full shoulder range of motion at the time of surgery.

Patients are advised to begin physical therapy as soon as possible after surgery, sometimes even the same day! The goal is to maintain the motion that was regained during surgery before any significant scar formation can occur. While most patients inevitably lose a bit of the full range of motion that was achieved in the operating room, they are generally still significantly improved compared to before surgery.

Recovery After Adhesive Capsulitis / Frozen Shoulder Surgery

For a comprehensive reading of the expected post-operative recovery, including restrictions, physical therapy progressions, and return to work/sport guidelines after arthroscopic shoulder capsular release surgery, please see our corresponding protocol on our physical therapy protocols page.