Adhesive Capsulitis

When the fibres of the shoulder’s joint capsule are bound down together, abduction and flexion of the shoulder is painfully limited. This may occur after any prolonged period of disuse in which the shoulder is not abducted or flexed for weeks at a time, for example after surgery or an accident. It may occasionally occur just overnight, as in diabetes mellitis. Deeper analysis reveals that the shoulder capsule must be large enough to cover the whole joint when the arm is fully abducted or flexed, yet has to fold together when the arm is by ones side. These folds or plicae are what adhere to one another if not moved regularly. The cure is to gently, but almost inevitably painfully, slowly increase the range of motion by “walking” ones fingers up a wall: first when directly facing the wall (flexion), and then with torso perpendicular to the wall (abduction). This can take weeks or months, but is almost always successful. The key is to go a little further up the wall every day or two. Rational pacing is essential.