Adhesive Capsulitis

KEY FEATURES

Essentials of Diagnosis

• Very painful shoulder triggered by minimal or no trauma

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

• Stiffness during the "freezing" phase and resolution during the "thawing" phase

General Considerations

• Also called “frozen shoulder,” a self-limiting but very debilitating disease

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

• Injury to the shoulder likely triggers mast cell activation and release of growth factors and cytokines

Demographics

• Commonly in patients aged 40–65 years

• Occurs more often in women than in men, especially in perimenopausal women or in patients with endocrine disorders, such as diabetes mellitus or thyroid disease

• The incidence of adhesive capsulitis is higher following shoulder trauma (such as surgery) or breast cancer care (such as mastectomy), which may create a pro-inflammatory condition in the shoulder

CLINICAL FINDINGS

• Painful shoulder that has a limited range of motion with both passive and active movements

• A useful clinical sign is limitation of movement of external rotation with the elbow by the side of the trunk (Table 43–1)

• Strength is usually normal but can appear diminished because of pain

• There are three phases

  • Inflammatory phase

    • Usually lasts 4–6 months

    • Patients report a very painful shoulder

    • No obvious clinical findings to suggest trauma, fracture, or rotator cuff tear

  • Freezing phase

    • Also usually lasts 4–6 months

    • The shoulder becomes stiffer and stiffer even though the pain is improving

  • Thawing phase: can take up to 1 year as the shoulder slowly regains its motion