Adhesive capsulitis (Frozen shoulder)

Frozen shoulder can occur for no apparent reason or develop after a painful injury.

It is associated with a tightening of the capsule that surrounds the shoulder joint. Often, the concentration of blood vessels in the joint area increases (called neovascularization), which leads to the inflammation and tightening of the shoulder capsule.

Generally, this tightening causes stiffness in the shoulder and a debilitating loss of range-of-motion that seriously hampers day-to-day activities.

Adhesive capsulitis is not a serious disease. However, it can cause debilitating symptoms that impair quality of life. Its clinical presentation typically involves two stages: 

First, a painful stage (sometimes called the "freezing" stage), during which pain is the predominating symptom. The patient's chief complaint is pain in the shoulder that may radiate into the arm. At this stage, it is often difficult to distinguish adhesive capsulitis from other shoulder conditions such as arthrosis or tendinitis.

A restriction of movement often occurs in the second stage (sometimes called the "frozen stage"). Patients describe difficulty in performing everyday activities such as getting dressed. During the physical examination, the physician observes a loss of range-of-motion.

What are the risk factors for frozen shoulder?

In some cases, the patient’s history will reveal a particular event, such as a recent surgery, an injury, or tendinitis, to which the condition can be traced, but frozen shoulder may also occur spontaneously. Some diseases (such as diabetes or a thyroid disorder) or medications (such as antiretroviral or iodine therapy) may also promote its onset.

An initial diagnosis may be suggested based on the patient’s history and clinical signs. The physical examination will generally show a loss of shoulder motion.

MRI is one of the main tools used in diagnosing frozen shoulder. It can confirm the diagnosis of adhesive capsulitis and eliminate other options in a differential diagnosis, such as a rotator cuff tear.

The first-line treatment generally involves a topical product, such as a cream, applied locally, and nonsteroidal anti-inflammatory drugs (NSAIDs). Physical therapy is also recommended to maintain the range of joint movement.

If this is not effective, other treatments may be considered, including embolization or even surgery.

Adhesive capsulitis embolization is an interventional radiology treatment for frozen shoulder where medical treatment has failed. The procedure involves inserting a catheter into an artery in the wrist and advancing it through the blood vessels to the arteries supplying the shoulder joint. When hypervascularity (an increase in the number and diameter of the blood vessels supplying the joint) is observed through angiography, the interventional radiologist injects a product to block those arteries, which is why the procedure is called embolization. This significantly lessens blood flow to the shoulder, which reduces inflammation and causes the symptoms to disappear. Embolization is an endovascular procedure, meaning that it is performed through the blood vessels, without any incision in the shoulder area.

Embolization requires only local anesthesia and an ambulatory stay (half a day). Patients can return home two hours after the procedure, with no other side effects than a scar a few millimeters long at the puncture site on the arm.

This procedure has been available to patients of the American Hospital of Paris for several years already. Every interventional radiologist on our staff has been specifically trained in the technique. In addition, having specialists such as rheumatologists and orthopedists at the American Hospital of Paris enables multidisciplinary discussions of each case to ensure that the most appropriate treatment is provided.