adhesive capsulitis (frozen shoulder)
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Introduction
Pain & restricted movement of the shoulder, generally in the absence of intrinsic joint disease.
Etiology
- may follow bursitis or tendonitis of the shoulder (rotator cuff tendonitis)
- may be associated with systemic disorders
- prolonged immobility of the arm
- arthritis[5]
- reflex sympathetic dystrophy
- trauma
- hemarthrosis
Epidemiology
- most common in women > 50 years[1][4] > 40 years[11]
- equally common in men & women[3]
- occurs more commonly in diabetics (30%)
- associated with diabetic retinopathy, but not neuropathy or proteinuria
Pathology
- the capsule of the shoulder is thickened
- mild chronic inflammatory infiltrate may be present
- fibrosis may be present, esp involving the coracohumeral ligament &/or glenohumeral capsule[11]
Clinical manifestations
- pain & decreased range of motion in all directions
- both active & passive movement are restricted*, especially external rotation & abduction
- pain & stiffness generally develop gradually over a period of months to 1 year, but may progress more rapidly
- pain is located diffusely about anterior & posterior regions of the shoulder joint
- may be early painful (freezing phase) lasting weeks to months followed by adhesive stiffening phase lasting 4-12 months[6]
- patients may be unable to recall trauma or injury
- pain may interfere with sleep, especially when patient rolls onto shoulder
- strength may be normal
- impingement sign may be mildly positive
- the shoulder is tender to palpation at the insertion of the deltoid tendon[2]
* contrast to rotator cuff tendonitis where mostly active range of motion is impaired
Radiology
- X-ray of shoulder shows osteopenia, otherwise normal
- arthrogram: < 15 mL of contrast can be injected into the joint
- magnetic resonance imaging diagnostic
- needed only to evaluate associated shoulder conditions
Differential diagnosis
- acromioclavicular arthritis
- does not present with severe stiffness & extremely poor range of motion
- pain with palpation of the acromioclavicular joint
- Milwaukee shoulder syndrome
- affects older women
- may be precipitated by overuse or trauma
- radiographic features:
- destruction of subchondral bone
- soft tissue swelling
- intra-articular effusion is usually present
- subacromial bursitis
- does not present with severe stiffness & extremely poor range of motion.
- commonly associated with impingement syndrome caused by overhead activities
- pain on palpation of the anterolateral aspect of the shoulder
- pain on resisted abduction beyond 75 degrees,
Management
- early mobilization of an arm after injury to a shoulder may prevent development of adhesive capsulitis
- gentle physical therapy with ultrasound
- as effective as more invasive intervention[7]
- glucocorticoid injection into glenohumeral joint
- may provide some relief of symptoms[2]
- associated with better outcomes[8]
- non-steroidal anti-inflammatory drugs (NSAIDs) be be of some benefit
- slow, but forceful injection of contrast into the joint may lyse adhesions & stretch the capsule, resulting in an improvement of shoulder movement
- manipulation under anesthesia may help some patients[7]
- refractory cases may require arthroscopic surgical release
- failure of 9-12-month course of nonoperative therapy[11]
- prognosis:
- most patients improve spontaneously in 12-18 months
- some may have permanent restriction of movement
- once the disease is established, therapy may have little impact on its natural course
More general terms
Additional terms
References
- ↑ Jump up to: 1.0 1.1 Harrison's Principles of Internal Medicine, 13th ed. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1994, pg 1709
- ↑ Jump up to: 2.0 2.1 2.2 Medical Knowledge Self Assessment Program (MKSAP) 11, 16, 17, 18, 19. American College of Physicians, Philadelphia 1998, 2012, 2015, 2018, 2021.
- ↑ Jump up to: 3.0 3.1 Clyman B, in: UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
- ↑ Jump up to: 4.0 4.1 Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 1961
- ↑ Jump up to: 5.0 5.1 Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004; 7th edition 2010
- ↑ Jump up to: 6.0 6.1 Geriatrics at your Fingertips, 13th edition, 2011 Reuben DB et al (eds) American Geriatric Society
- ↑ Jump up to: 7.0 7.1 7.2 Rangan A, Brealey SD, Keding A et al. Management of adults with primary frozen shoulder in secondary care (UK FROST): A multicentre, pragmatic, three-arm, superiority randomised clinical trial. Lancet 2020 Oct 3; 396:977 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33010843 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31965-6/fulltext
- ↑ Jump up to: 8.0 8.1 8.2 Challoumas D, Biddle M, McLean M et al Comparison of Treatments for Frozen Shoulder. A Systematic Review and Meta-analysis. JAMA Netw Open. 2020;3(12):e2029581. Dec 16 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33326025 PMCID: PMC7745103 Free PMC articl https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2774247
- ↑ Ramirez J Adhesive Capsulitis: Diagnosis and Management Am Fam Physician. 2019 Mar 1;99(5):297-300. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30811157 Free article
- ↑ Le HV, Lee SJ, Nazarian A, Rodriguez EK. Adhesive capsulitis of the shoulder: review of pathophysiology and current clinical treatments. Shoulder Elbow. 2017 Apr;9(2):75-84. PMID: https://www.ncbi.nlm.nih.gov/pubmed/28405218 PMCID: PMC5384535 Free PMC article
- ↑ Jump up to: 11.0 11.1 11.2 11.3 Redler LH, Dennis ER. Treatment of adhesive capsulitis of the shoulder. J Am Acad Orthop Surg. 2019;27:e544-e554. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30632986