Adhesive capsulitis affects 2% to 5% of the population. It is slightly more common in women than in men, and is 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.
Refractory cases may require a surgical capsular release. This can be performed reliably and satisfactorily with arthroscopic techniques.
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.
A poor understanding of the pathogenesis of adhesive capsulitis underpins the continued debate regarding the best treatment strategies. There is a paucity of good-quality randomised controlled trials that help guide clinicians by providing a step-wise and systematic treatment algorithm. However, one critical review of available evidence found that most interventions, including non-operative treatments, are designed to mitigate or alleviate symptoms, speed up recovery, and reduce the duration of painful symptoms and limited range of motion.
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
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)
- age 40 to 70 years
- diabetes mellitus
- prior history of adhesive capsulitis
- shoulder pain and immobilisation
- previous shoulder surgery
- female sex
- thyroid disease
1st investigations to order
- plain film radiographs
Investigations to consider
- MRI/MR arthrogram shoulder
- CT arthrogram
- Posterior glenohumeral dislocation
- Rotator cuff injury
- Subacromial rotator cuff impingement
- ACR appropriateness criteria: chronic shoulder pain - atraumatic
Rotator cuff injuryMore Patient leaflets
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