Adhesive Capsulitis (Frozen Shoulder) Vignette
Patient Vignette – Adhesive Capsulitis
R.P. is a 56-year-old right-hand dominant female. She reports a gradual onset of pain over one year. She is an active person, but has never had any specific injuries to her left shoulder or arm. Her best guess is that the pain started when she advanced overhead activity at the gym. As the level of pain increased, her range of motion decreased. She ultimately had difficulty with normal daily activities, such as fastening her bra, and the pain began waking her at night. This was the first time she had problems with her shoulder, so she had never had therapy, injections or surgery.
Clinic Visit #1
R.P. had X-rays before she was seen by the provider. When the provider entered the room, they started by reviewing a comprehensive history related to the shoulder injury. R.P. expressed frustration that she had never “done anything wrong” with her shoulder. She also described the gradual worsening of symptoms over several months, mixed with loss of range of motion. The provider did a series of exams, including a careful look at both shoulders, tests for loss of range of motion (motion was decreased on the left) and weakness. R.P. had excellent strength and no obvious deformity, but she had profound loss of range of motion in every direction.
Adhesive Cap Xray AP
were within the normal limits, with no evidence of fracture or other obvious injury.
The provider diagnosed adhesive capsulitis (frozen shoulder), and recommended an ultrasound-guided steroid injection and physical therapy.
Clinic Visit #2
R.P. blocked out 30 minutes on a Monday afternoon for her next visit. On arrival she read and signed consent for the injection, and asked questions that were not addressed. The procedure was done with R.P. lying on her right side. (Ultrasound was used to ensure proper placement of the needle and medication within the shoulder joint.) Both the area to be injected and the ultrasound machine were prepared in a sterile fashion. The needle was inserted into the back of the shoulder. (Patient pictured is not R.P., but is used for demonstration purposes.)
Lidocaine was used to numb the skin, and then the needle was advanced into the shoulder joint (ultrasound image pictured).
Adhesive Cap US Inj
Note the needle (red arrows), ball (white arrow), and socket/labrum (yellow arrow). More lidocaine was used which served to numb the shoulder joint. At the conclusion of the procedure, a steroid was injected to help calm inflammation and manage pain. R.P. tolerated the injection well and was able to drive herself home after the procedure.
After the Procedure
When the effects of the Lidocaine wore off, R.P. reported some discomfort, but this was managed well with over-the-counter medication. Over the next few days the degree of pain in the shoulder decreased. Therapy was started about one week after the procedure, with an emphasis on regaining range of motion, and to a lesser degree increasing strength and stability of the shoulder.
Clinic Visit #3
R.P. reported back to the provider about 6 weeks and again at 3 months after the injection. While R.P. reported some persistent discomfort, she felt much better than before the procedure, including significantly improved range of motion. She stated that she continues to notice improvement in physical therapy, and ultimately transitioned to home exercises alone.
Further testing demonstrated a rotator cuff tear, which continues to cause mild discomfort. She is considering surgery for the rotator cuff tear. Today the R.P. reports 75% overall improvement, with near complete improvement in her symptoms related to the frozen shoulder.