Adhesive capsulitis

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 21 Oct 2024

Last updated: 24 Feb 2023

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.

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][3]

A poor understanding of the pathogenesis of adhesive capsulitis underpins the continued debate regarding the best treatment strategies.[3] There is a paucity of good-quality randomised controlled trials that help guide clinicians by providing a step-wise and systematic treatment algorithm.[4] 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.[5]

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

Full details

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)

Full details

Risk factors

age 40 to 70 years
diabetes mellitus
prior history of adhesive capsulitis
shoulder pain and immobilisation
previous shoulder surgery
female sex
thyroid disease

Full details

Diagnostic investigations

1st investigations to order

plain film radiographs
ultrasound

Full details

Investigations to consider

MRI/MR arthrogram shoulder
CT arthrogram

Full details

Treatment algorithm

ACUTE

all patients

Contributors

Authors

Matthew T. Provencher, MD, CAPT MC USNR

Complex Shoulder Knee and Sports Surgery

The Steadman Clinic

Steadman Philippon Research Institute

Vail

Disclosures

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

Staff Surgeon

Team Physician

Orthopaedic Sports Medicine and Shoulder Surgery

Naval Health Clinic

US Naval Academy

Annapolis

Disclosures

LL declares that he has no competing interests.

Jennifer Smith, MD, LCDR MC USN

Staff Surgeon

Orthopaedic Sports Surgery

Naval Medical Center San Diego

San Diego

Disclosures

JS declares that she has no competing interests.

Peer reviewers

Matthew Busam, MD

Orthopedic Surgeon

Cincinnati Sports Medicine Research and Education Foundation

Cincinnati

Disclosures

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

San Diego

Disclosures

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

London

Disclosures

SC declares that he has no competing interests.

Differentials
- Posterior glenohumeral dislocation
- Rotator cuff injury
- Subacromial rotator cuff impingement
More Differentials
Guidelines
- ACR appropriateness criteria: chronic shoulder pain
More Guidelines
Patient information
Rotator cuff injury
More Patient information
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Adhesive capsulitis

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Investigations to consider

Treatment algorithm

all patients

Contributors

Authors

Matthew T. Provencher, MD, CAPT MC USNR

Disclosures

Lance LeClere, MD, LCDR MC USN

Disclosures

Jennifer Smith, MD, LCDR MC USN

Disclosures

Peer reviewers

Matthew Busam, MD

Disclosures

Daniel Solomon, MD

Disclosures

Steven Corbett, BSc, PhD, FRCS (Tr & Orth)

Disclosures

Differentials

Guidelines

Patient information

Log in or subscribe to access all of BMJ Best Practice

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