Adhesive Capsulitis

A condition, also known as “frozen shoulder,” characterized by gradual, painful restriction of movement in the shoulder. The strong connective tissue surrounding the shoulder joint (known as the shoulder capsule) becomes thickened and tight, and stiff bands of tissue known as adhesions develop, limiting mobility. Often there is also a reduction in synovial fluid, which ordinarily lubricates joints. Adhesive capsulitis is associated with a number of other conditions, including shoulder trauma, cerebral (brain) conditions, heart and lung conditions, and diabetes. Its likelihood of occurring increases with age.

To diagnose adhesive capsulitis, a doctor first conducts a physical examination and takes a medical history, asking the patient about his symptoms and examining the shoulder and its movement. The doctor may order a number of tests: Standard x-rays can be used to diagnose fractures or other problems of the bones, but soft tissues such as muscles and tendons don’t show up on x-rays, so they can’t be used to diagnose adhesive capsulitis. In an arthrogram, a contrast dye is injected into the shoulder joint to help doctors visualize structures such as the rotator cuff, which is composed of tendons that hold the shoulder joint in place. Ultrasound, in which extremely high-frequency sound waves are passed through the shoulder, can create images of the rotator cuff and other structures. Magnetic resonance imaging (MRI), in which magnetic waves are used to produce images, may be used to create a cross-section image of the shoulder.

Treatment for adhesive capsulitis usually starts with nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen, along with application of heat followed by gentle stretching exercises. In some cases, transcutaneous electrical nerve stimulation (TENS), in which a device is used to administer electricity that interferes with nerve impulses, may be effective at reducing pain. If these measures fail to adequately control symptoms, injections of corticosteroids into the shoulder are often very successful. (Anyone with diabetes should be aware that steroids tend to raise blood glucose levels.) In rare cases, the shoulder may need to be manipulated under general anesthesia, and an arthroscopic procedure (using miniature surgical devices inserted through small incisions) can be used to sever the remaining adhesions.

Robert S. Dinsmoor, a medical writer and editor based in Massachusetts, is a contributing editor of Diabetes Self-Management.

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