Adhesive capsulitis

Let’s set things straight immediately: adhesive capsulitis is a benign condition that resolves spontaneously without surgery, except in very rare cases.

Clinically, adhesive capsulitis initially resembles bursitis or tendinitis (pain on exertion, worse at night) but, as the weeks go by, the shoulder becomes increasingly stiff. This is the first stage: inflammation. A total loss of movement follows: the “frozen shoulder” stage. As a result of inflammation, excessive fibrous tissue has formed on the shoulder capsule, causing adhesions. This makes it difficult to raise the arm or put the hand behind the back. In the third and final “recovery” stage, movement is regained as spontaneously as it was lost. Usual course: 6 to 18 months.

The cause? It remains unknown in most cases. (In clinical medicine, we presumptuously use the term “idiopathic”, thus designating the doctor as the idiot and the patient as pathetic…). It is probably due to a phenomenon of excessive scarring (i.e., an immune system that produces too much fibrous tissue) following a very minor injury or prolonged immobilization. People with other autoimmune disorders (such as diabetes or thyroid pathologies) are at increased risk and experience more severe episodes. Fortunately, the human body has “biofeedback” mechanisms that tend to make adjustments and gradually resorb the fibrous tissue that has formed. The drawback is that this takes time, sometimes up to two or three years (in insulin-dependent diabetics).

The goal of treatment is to maintain movement (exercises, physiotherapy) and control inflammation (if any) with anti-inflammatory medication, ice, cortisone injections (stage 1).

If pain and inflammation do not decrease with rest and NSAID, intra-articular cortisone injection (distensive arthrogram) should be given sooner than later. Such injection is difficult to perform without radiologic guidance of the needle. 

Hence, I perform all my distensive arthrogram under ultrasound guidance, at my office. Usually it reduces significantly the pain, and allows a much more efficient physiotherapy to restore motion. Given the above, surgery, or manipulation under anesthesia, is hard to justify, other than out of impatience. If it did not occasionally cause major complications (fracture, cuff tear, nerve section, etc.), it would be legitimate. However, it is even less so for a pathology that tends to heal on its own.

“I am a professional pilot for a major airline. I suffered a torn rotator cuff, was unable to work and entered the public health system…So I booked an appointment and realized immediately that I had not only found the right surgeon but wasted 10 months in the public system. Within 6 months from Dr. Beauchamp’s surgery, I was back to work. Dr Beauchamp told me he would treat me like one of his family members and he did.”

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