Adhesive capsulitis

• Frozen shoulder syndrome

• 726.0 Adhesive capsulitis of shoulder

• M75.00 Adhesive capsulitis of unspecified shoulder

• 4E: Impaired joint mobility, motor function, muscle performance, and rom associated with localized inflammation

Description

• Self-limiting shoulder pain and dysfunction due to:
  • Localized inflammation of glenohumeral joint capsule
  • Paucity of synovial fluid
  • Fibrosis of capsule causing adherence to humeral head
• Three pathological pathways
  • Primary (idiopathic)
  • Secondary: can be attributed to a known intrinsic, extrinsic, or systemic cause
  • Tertiary: postoperative or post-fracture
• Adhesive capsulitis (AC) can be divided into 4 stages
  • Stage 1: “Pre-adhesive”
    • Near normal range of motion, pain at end points of motion and mild synovitis
  • Stage 2: “Freezing”
    • Marked loss of motion, pain at end points with thickened read synovitis
  • Stage 3: “Frozen”
    • Marked loss of motion, painless range of motion with capsule fibrosis and adhesions
  • Stage 4: “Thawing”
    • Improved glenohumeral motion, painless range of motion; no synovitis present

Essentials of Diagnosis

• Extrinsic factors
  • Cardiopulmonary disease
  • Cervical disc
  • CVA
  • Humerus fractures
  • Parkinson’s disease
• Intrinsic factors
  • Dupuytren’s disease
  • Rotator cuff tendinitis
  • Rotator cuff tears
  • Biceps tendinitis
  • Calcific tendinitis
• Systemic factors
  • Diabetes mellitus
  • Hypothyroidism
  • Hyperthyroidism
  • Hypoadrenalism
  • Dupuytren’s disease

Demographics

• Affects 2 to 5% of the general population
• Affects 10 to 38% of patients with thyroid disease or diabetes mellitus
• Primary AC generally affects individuals aged 40-65 years
• Greater incidence in females than males
• Occurrence in one shoulder increases the risk of contralateral shoulder involvement 5 to 34%

Signs and Symptoms

• Pain in anterior lateral shoulder described as achy at rest and sharp with end-range motion
• Symptoms typically present for < 3 months if stage 1
• Nighttime pain and pain when reaching behind the back are common
• Active and passive ROM are equally limited

Functional Implications

• Pain/limitation with overhead activities
• Pain/limitation with reaching
• Pain/limitation with lifting
• Pain/limitation while dressing
• Pain/limitation with sustained or repetitive shoulder activities
• Pain at night disrupting sleep

Possible Contributing Causes

• Degenerative changes at the acromioclavicular (AC) joint
• Rotator cuff tendinopathy
• Bicipital tendinopathy
• Humeral fracture
• Capsular tightness
• Increased thoracic kyphosis and sub-optimal posture
• History of trauma
• Diabetes mellitus
• Treatment with antiretroviral therapy

Differential Diagnosis

• Cervical radiculopathy
• Referred pain from lungs or diaphragm
• Full-thickness rotator cuff tear
• Glenohumeral arthritis
• Glenohumeral contracture
• Labral tear
• Subacromial impingement
• Neuropathy (suprascapular nerve)
• Internal impingement

Imaging

• Radiograph
  • Glenohumeral joint space
  • OA
  • Allows for secondary causes to be viewed
  • Views: AP, axillary lateral, scapular Y-view
• MRI
  • Not required to make the diagnosis of adhesive capsulitis
  • Usually will demonstrate decreased hydration
  • Tissue quality
  • Capsulolabral and biceps labral pathology

Diagnostic Procedure

• Sub-acromial injection with lidocaine: if pain ...