Frozen Shoulder

Adhesive capsulitis, also known as frozen shoulder, is a condition characterized by pain and stiffness in the shoulder joint. It typically develops gradually, worsens over time, and then slowly improves on it’s own, but it can take 2 years to resolve.

With good early diagnosis and treatment, symptoms can resolve in a matter of months.

Symptoms

Pain: Often dull or aching, worsens with movement or at night.

  • Stiffness: Significant reduction in range of motion (“can not put on my bra or comb my hair”).

  • Phases:

    1. Freezing phase: Increasing pain and progressive loss of motion (lasts 6 weeks to 9 months).

    2. Frozen phase: Pain may improve, but stiffness remains (lasts 4 to 6 months).

    3. Thawing phase: Gradual return of motion (lasts 6 months to 2 years).

Causes:

Often idiopathic (no clear cause), but associated with:

  • Diabetes (especially Type 1)

  • Thyroid disorders

  • Previous shoulder injury or surgery

  • Prolonged immobilization.

Is more common in women

  • Female-to-male ratio: Approximately 2:1

  • Most commonly affects adults aged 40 to 60

  • Particularly common in postmenopausal women.

Why more common in women?

The exact reason isn't fully understood, but possible contributing factors include:

  • Hormonal changes (especially during menopause)

  • Higher rates of autoimmune conditions in women

  • Increased prevalence of thyroid disorders, which are risk factors for frozen shoulder.

Diagnosis:

  • A good clinical exam should be enough to diagnose frozen shoulder.

  • Imaging like x-rays could be helpful to rule out other reason of limited range of motion, like severe osteoarthritis.

  • Other modalities like diagnostic ultrasound or MRI can be used to rule other pathologies when the diagnosis is not clear.

Treatment:

  • first-line:

    • Good Physical therapy, focusing on Capsule Stretching exercises

    • Hydrodilatation under Ultrasound Guidance. More of that later.

    • Platelet Rich Plasma injections (PRP)

  • Surgical options (rarely needed):

    • Manipulation under anesthesia (MUA)

    • Arthroscopic capsular release.

What is Hydrodilatation?

Hydrodilatation under Ultrasound Guidance is a minimally invasive treatment for frozen shoulder (adhesive capsulitis). It involves injecting a fluid mixture  (usually saline, corticosteroid, and local anesthetic) into the shoulder joint capsule to stretch it and improve mobility. Usually a suprascapular nerve block is done prior to the hydrodilatation procedure.

  • It helps stretch the capsule (saline)

  • Reduce inflammation (corticosteroid)

  • Relieve pain and improve range of motion

How It’s Done:

  • Dr. Galvez performs all these injections under ultrasound Guidance.

  • Ultrasound guidance ensures precise placement of the needle into the shoulder joint

  • Typical injectate includes:

    • Normal saline (to distend the capsule)

    • Corticosteroid (e.g., triamcinolone)

    • Local anesthetic (e.g., lidocaine)

  • The total volume injected is usually 20-40 mL, depending on patient tolerance.

Benefits:

  • Can provide faster pain relief than physical therapy or steroid injection alone

  • May improve range of motion more quickly in the freezing or early frozen stages.

  • Minimally invasive and usually well tolerated.

Risks & Considerations:

  • Mild, temporary post-procedure discomfort

  • Rare risk of infection or bleeding

  • Works best when followed by physiotherapy immediately after or soon after the procedure.

Effectiveness:

  • Supported by clinical studies, particularly in early to mid stages

  • Most effective when done in combination with ongoing physical therapy

  • Not always a cure, but can significantly speed up recovery in many patients

Prognosis:

  • Most patients recover fully, though some may have mild long-term stiffness.

  • Earlier intervention with physical therapy often improves outcomes.

  • Early intervention with physical therapy and hydrodilatation often improves outcomes.