Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ 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 capsulePaucity of synovial fluidFibrosis of capsule causing adherence to humeral headThree pathological pathways Primary (idiopathic)Secondary: can be attributed to a known intrinsic, extrinsic, or systemic causeTertiary: postoperative or post-fracture Adhesive capsulitis (AC) can be divided into 4 stagesStage 1: “Pre-adhesive”Near normal range of motion, pain at end points of motion and mild synovitisStage 2: “Freezing”Marked loss of motion, pain at end points with thickened read synovitisStage 3: “Frozen”Marked loss of motion, painless range of motion with capsule fibrosis and adhesionsStage 4: “Thawing” Improved glenohumeral motion, painless range of motion; no synovitis present +++ Essentials of Diagnosis ++ Extrinsic factorsCardiopulmonary diseaseCervical discCVAHumerus fracturesParkinson’s diseaseIntrinsic factorsDupuytren’s diseaseRotator cuff tendinitisRotator cuff tearsBiceps tendinitisCalcific tendinitisSystemic factorsDiabetes mellitusHypothyroidismHyperthyroidismHypoadrenalismDupuytren’s disease +++ Demographics ++ Affects 2 to 5% of the general populationAffects 10 to 38% of patients with thyroid disease or diabetes mellitusPrimary AC generally affects individuals aged 40-65 yearsGreater incidence in females than malesOccurrence 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 motionSymptoms typically present for < 3 months if stage 1Nighttime pain and pain when reaching behind the back are commonActive and passive ROM are equally limited +++ Functional Implications ++ Pain/limitation with overhead activitiesPain/limitation with reachingPain/limitation with liftingPain/limitation while dressingPain/limitation with sustained or repetitive shoulder activitiesPain at night disrupting sleep +++ Possible Contributing Causes ++ Degenerative changes at the acromioclavicular (AC) jointRotator cuff tendinopathyBicipital tendinopathyHumeral fractureCapsular tightnessIncreased thoracic kyphosis and sub-optimal postureHistory of traumaDiabetes mellitusTreatment with antiretroviral therapy +++ Differential Diagnosis ++ Cervical radiculopathyReferred pain from lungs or diaphragmFull-thickness rotator cuff tearGlenohumeral arthritisGlenohumeral contractureLabral tearSubacromial impingementNeuropathy (suprascapular nerve)Internal impingement +++ Imaging ++ RadiographGlenohumeral joint spaceOAAllows for secondary causes to be viewedViews: AP, axillary lateral, scapular Y-viewMRI Not required to make the diagnosis of adhesive capsulitisUsually will demonstrate decreased hydrationTissue qualityCapsulolabral and biceps labral pathology +++ Diagnostic Procedure ++ Sub-acromial injection with lidocaine: if pain ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.