Adhesive Capsulitis

Key Features

• Self-limited but very debilitating disease

• Caused by acute inflammation of the capsule followed by scarring and remodeling

• Very painful shoulder triggered by minimal or no trauma

• Pain out of proportion to clinical findings during the inflammatory phase

• Commonly seen in patients 40- to 65-years-old

• More common in women than men, especially in perimenopausal women or in patients with endocrine disorders, such as diabetes mellitus or thyroid disease

Clinical Findings

• Painful shoulder that has limited range of motion

• Strength is usually normal but can appear diminished when the patient is in pain

• There are three phases

  • Inflammatory phase usually lasts 4–6 months; patients complain of a very painful shoulder without obvious clinical findings of trauma, fracture, or rotator cuff tear

  • "Freezing" phase usually lasts 4–6 months; shoulder becomes progressively stiffer even though the pain is improving

  • "Thawing" phase can take up to a year as the shoulder slowly regains its motion

• Total duration of an idiopathic frozen shoulder

  • Usually about 24 months

  • Can be much longer for patients who have trauma or an endocrinopathy

Diagnosis

• Usually a clinical diagnosis; an extensive work-up is not necessary

• However, standard anteroposterior, axillary, and lateral glenohumeral radiographs are useful to rule out glenohumeral arthritis

• Imaging can also rule out calcific tendinitis

Treatment

• During the acute "freezing" phase,

  • NSAIDs and physical therapy are recommended

  • Intra-articular corticosteroid injection or oral prednisone may provide short-term benefit

• Anti-inflammatory medication is not as helpful during the "thawing" phase as it is during the "freezing" phase

• Surgical treatments include manipulation under anesthesia and arthroscopic release