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 physical therapy and observation. Evidence shows that nonsteroidal 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 characterized 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-limited 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 randomized controlled trials that help guide clinicians by providing a stepwise and systematic treatment algorithm. However, one critical review of available evidence found that most interventions, including nonoperative 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
- shoulder pain
- alternative diagnosis not suggested by provocative maneuvers
- negative Spurling maneuver (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 immobilization
- previous shoulder surgery
- female sex
- thyroid disease
1st investigations to order
- plain film radiographs
Investigations to consider
- MRI/MR arthrogram shoulder
- CT arthrogram
Matthew T. Provencher, MD, CAPT MC USNR
Complex Shoulder Knee and Sports Surgery
The Steadman Clinic
Steadman Philippon Research Institute
MTP is a consultant for Arthrex and Joint Restoration Foundation. MTP receives royalties from Arthrex and has received an honorarium from Arthrosurface. He receives research funding from Vail Health and Steadman Philippon Research Institute.
Lance LeClere, MD, LCDR MC USN
Orthopaedic Sports Medicine and Shoulder Surgery
Naval Health Clinic
US Naval Academy
LL declares that he has no competing interests.
Jennifer Smith, MD, LCDR MC USN
Orthopaedic Sports Surgery
Naval Medical Center San Diego
JS declares that she has no competing interests.
Matthew Busam, MD
Cincinnati Sports Medicine Research and Education Foundation
MB declares that he has no competing interests.
Daniel Solomon, MD
Co-Director of Orthopedic Sports and Shoulder Service
Department of Orthopedic Surgery
Naval Medical Center San Diego
DS declares that he has no competing interests.
Steven Corbett, BSc, PhD, FRCS (Tr & Orth)
Consultant Orthopaedic Surgeon
Guy's and St Thomas’ Hospital NHS Foundation Trust
SC declares that he has no competing interests.
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