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Adhesive Capsulitis

This is a condition in which the lining of the shoulder joint becomes inflamed, and subsequently becomes thicker. This causes pain initially, followed by progressive loss in range of motion of the shoulder. There are two types of adhesive capsulitis. Primary adhesive capsulitis is a rheumatologic type problem, and may follow a minor injury. This results in significant loss of motion over time, with gradual resolution over a two to three year course. This is more common in patients who have hypothyroidism or diabetes, and can also be more difficult to treat in patients with these conditions.
The second type of adhesive capsulitis is secondary to an underlying problem such as a rotator cuff tear or biceps abnormality in the shoulder. The pain from this problem causes the patient to stop moving the shoulder, and a secondary adhesive capsulitis develops. Secondary adhesive capsulitis will generally regain motion more rapidly, but once motion has been regained, then further treatment may be required for the underlying problem.

The initial treatment is the same for both the primary and secondary adhesive capsulitis, which is an aggressive range of motion program. Most patients will respond well to exercising and stretching on their own, and I also would recommend a course of formal physical therapy for additional help in stretching the shoulder. If the patient does not improve with this regimen, then manipulation under anesthesia with an intra-articular steroid injection may be necessary. In patients with diabetes or hypothyroidism, or in patients who fail to improve with manipulation alone, then a left shoulder arthroscopy with capsular release and release of the rotator cuff interval may also be necessary. Anti-inflammatory medication may be helpful in reducing the inflammation, although in general a corticosteroid injection is less helpful than would be the case for a rotator cuff problem. These problems are often slow to resolve. If the motion improves but the pain persists, then this would make the diagnosis of a secondary adhesive capsulitis more likely, and an MRI scan is performed in these patients to rule out rotator cuff pathology or other underlying shoulder problems.

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