Adhesive capsulitis

Last reviewed: February 2020

Last updated: April 2018

Summary

Affects 2% to 5% of the population, slightly more common in women than in men, and most common in people between 40 and 70 years of age.

Recent history of traumatic shoulder injury, prior surgery to affected shoulder, diabetes mellitus, thyroid disease, and previous history of adhesive capsulitis are all risk factors for developing adhesive capsulitis.

Mainstay of treatment is physiotherapy and observation. Evidence shows that non-steroidal anti-inflammatory drugs and injected corticosteroids may also be beneficial therapies.

Refractory cases may require a surgical capsular release. This can be performed reliably and satisfactorily with arthroscopic techniques.

Definition

Adhesive capsulitis is a chronic fibrosing condition characterised by insidious and progressive severe restriction of both active and passive shoulder range of motion in the absence of a known intrinsic disorder of the shoulder. It is generally regarded as a self-limiting condition that usually resolves within 18 to 24 months. However, some reports have indicated that many patients can have residual pain and limited range of motion lasting several years.[1][2]

It should be noted by treating clinicians that there remains a poor overall understanding of the exact pathogenesis of adhesive capsulitis. In addition, debate continues regarding the best treatment strategies. Unfortunately, there is a paucity of good-quality, randomised controlled trials that help to guide treating clinicians by providing a step-wise and systematic treatment algorithm. However, a critical review of available evidence shows that adhesive capsulitis is a self-limiting process and that most interventions, including non-operative treatments, are designed to mitigate or alleviate symptoms. They are also designed to speed up recovery and shorten the duration of painful symptoms and limited range of motion.[3]

History and exam

Key diagnostic factors

shoulder stiffness
decreased shoulder active range of motion
decreased shoulder passive range of motion
positive coracoid pain test
positive shoulder shrug test

More key diagnostic factors

Other diagnostic factors

presence of risk factors
shoulder pain
alternative diagnosis not suggested by provocative manoeuvres
negative Spurling manoeuvre (to exclude cervical spine radiculopathy)
negative Hawkins test (to exclude rotator cuff impingement)
negative Neer test (to exclude shoulder impingement)
negative Speed test (to exclude superior labrum from anterior to posterior [SLAP] tear)
negative O'Brien test (to exclude superior labrum from anterior to posterior [SLAP] lesion)
negative Yergason test (to exclude proximal biceps tendon pathology)
negative apprehension test (to exclude anterior shoulder instability)
negative relocation test (to further exclude anterior shoulder instability)
negative Kim test (to exclude posteroinferior labral lesion of the shoulder)

Other diagnostic factors