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Adhesive capsulitis of shoulder

adhesive capsulitis of shoulder, adhesive capsulitis of shoulder treatment
Adhesive capsulitis also known as frozen shoulder is a painful and disabling disorder of unclear cause in which the shoulder capsule, the connective tissue surrounding the glenohumeral joint of the shoulder, becomes inflamed and stiff, greatly restricting motion and causing chronic pain Pain is usually constant, worse at night, and with cold weather Certain movements or bumps can provoke episodes of tremendous pain and cramping The condition is thought to be caused by injury or trauma to the area and may have an autoimmune component

Risk factors for frozen shoulder include tonic seizures, diabetes mellitus, stroke, accidents, lung disease, connective tissue diseases, thyroid disease, and heart disease Treatment may be painful and taxing and consists of physical therapy, occupational therapy, medication, massage therapy, hydrodilatation or surgery A physician may also perform manipulation under anesthesia, which breaks up the adhesions and scar tissue in the joint to help restore some range of motion Pain and inflammation can be controlled with analgesics and NSAIDs

People who suffer from adhesive capsulitis usually experience severe pain and sleep deprivation for prolonged periods due to pain that gets worse when lying still and restricted movement/positions The condition can lead to depression, problems in the neck and back, and severe weight loss due to long-term lack of deep sleep People who suffer from adhesive capsulitis may have extreme difficulty concentrating, working, or performing daily life activities for extended periods of time The condition tends to be self-limiting and usually resolves over time without surgery Most people regain about 90% of shoulder motion over time


  • 1 Signs and symptoms
  • 2 Diagnosis
    • 21 MRI and ultrasound
  • 3 Prevention
  • 4 Management
  • 5 Epidemiology
  • 6 See also
  • 7 References
  • 8 External links

Signs and symptomsedit

Movement of the shoulder is severely restricted, with progressive loss of both active and passive range of motion1 The condition is sometimes caused by injury, leading to lack of use due to pain, but also often arises spontaneously with no obvious preceding trigger factor idiopathic frozen shoulder Rheumatic disease progression and recent shoulder surgery can also cause a pattern of pain and limitation similar to frozen shoulder Intermittent periods of use may cause inflammation

In frozen shoulder, there is a lack of synovial fluid, which normally helps the shoulder joint, a ball and socket joint, move by lubricating the gap between the humerus upper arm bone and the socket in the shoulder blade The shoulder capsule thickens, swells, and tightens due to bands of scar tissue adhesions that have formed inside the capsule As a result, there is less room in the joint for the humerus, making movement of the shoulder stiff and painful This restricted space between the capsule and ball of the humerus distinguishes adhesive capsulitis from a less complicated, painful, stiff shoulder2


One sign of a frozen shoulder is that the joint becomes so tight and stiff that it is nearly impossible to carry out simple movements, such as raising the arm The movement that is most severely inhibited is external rotation of the shoulder

People complain that the stiffness and pain worsen at night Pain due to frozen shoulder is usually dull or aching It can be worsened with attempted motion, or if bumped A physical therapist, osteopath or chiropractor, physician, physician assistant, or nurse practitioner may suspect the patient has a frozen shoulder if a physical examination reveals limited shoulder movement Frozen shoulder can be diagnosed if limits to the active range of motion range of motion from active use of muscles are the same or almost the same as the limits to the passive range of motion range of motion from a person manipulating the arm and shoulder An arthrogram or an MRI scan may confirm the diagnosis, though in practice this is rarely required

The normal course of a frozen shoulder has been described as having three stages:3

  • Stage one: The "freezing" or painful stage, which may last from six weeks to nine months, and in which the patient has a slow onset of pain As the pain worsens, the shoulder loses motion4
  • Stage two: The "frozen" or adhesive stage is marked by a slow improvement in pain but the stiffness remains This stage generally lasts from four to nine months
  • Stage three: The "thawing" or recovery, when shoulder motion slowly returns toward normal This generally lasts from 5 to 26 months5

MRI and ultrasoundedit

Imaging features of adhesive capsulitis are seen on non-contrast MRI, though MR arthrography and invasive arthroscopy are more accurate in diagnosis6 Ultrasound and MRI can help in diagnosis by assessing the coracohumeral ligament, with a width of greater than 3 mm being 60% sensitive and 95% specific for the diagnosis The condition can also be associated with edema or fluid at the rotator interval, a space in the shoulder joint normally containing fat between the supraspinatus and subscapularis tendons, medial to the rotator cuff Shoulders with adhesive capsulitis also characteristically fibrose and thicken at the axillary pouch and rotator interval, best seen as dark signal on T1 sequences with edema and inflammation on T2 sequences7 A finding on ultrasound associated with adhesive capsulitis is hypoechoic material surrounding the long head of the biceps tendon at the rotator interval, reflecting fibrosis In the painful stage, such hypoechoic material may demonstrate increased vascularity with Doppler ultrasound8


To prevent the problem, a common recommendation is to keep the shoulder joint fully moving to prevent a frozen shoulder Often a shoulder will hurt when it begins to freeze Because pain discourages movement, further development of adhesions that restrict movement will occur unless the joint continues to move full range in all directions adduction, abduction, flexion, rotation, and extension Physical therapy and occupational therapy can help with continued movement


Management of this disorder focuses on restoring joint movement and reducing shoulder pain, involving medications, physical therapy, and/or surgical intervention Treatment may continue for months, there is no strong evidence to favor any particular approach9

Medications frequently used include NSAIDs; corticosteroids are used in some cases either through local injection or systemically Manual therapists like osteopaths, chiropractors and physiotherapists may include massage therapy and daily extensive stretching9 Another osteopathic technique used to treat the shoulder is called the Spencer technique

If these measures are unsuccessful, manipulation of the shoulder under general anesthesia to break up the adhesions is sometimes used9 Hydrodilatation or distension arthrography is controversial10 Surgery to cut the adhesions capsular release may be indicated in prolonged and severe cases; the procedure is usually performed by arthroscopy11 Surgical evaluation of other problems with the shoulder, eg, subacromial bursitis or rotator cuff tear may be needed


The incidence of adhesive capsulitis is approximately 3 percent in the general population Occurrence is rare in children and people under 40 but peaks between 40 and 70 years of age9 At least in its idiopathic form, the condition is much more common in women than in men 70% of patients are women aged 40–60 Frozen shoulder is more frequent in diabetic patients and is more severe and more protracted than in the non-diabetic population12

People with diabetes, stroke, lung disease, rheumatoid arthritis, or heart disease are at a higher risk for frozen shoulder Injury or surgery to the shoulder or arm may cause blood flow damage or the capsule to tighten from reduced use during recovery2 Adhesive capsulitis has been indicated as a possible adverse effect of some forms of highly active antiretroviral therapy HAART Cases have also been reported after breast and lung surgery13

See alsoedit

  • Calcific tendinitis
  • Milwaukee shoulder syndrome


  1. ^ Jayson, M I V 1981 "Frozen Shoulder: Adhesive Capsulitis" British Medical Journal Clinical Research Edition 283 6298: 1005–6 JSTOR 29503905 doi:101136/bmj28362981005 
  2. ^ a b "Frozen shoulder - Causes" Retrieved 2011-07-05 
  3. ^ "Your Orthopaedic Connection: Frozen Shoulder" Retrieved 2008-01-28 
  4. ^ Burnham MD, Jeremy "Frozen Shoulder Diagnosis & Management" Retrieved 25 January 2017 
  5. ^ "Reduce Frozen Shoulder Recovery Time" 2016-06-24 Retrieved 2016-07-12 
  6. ^ Neviaser TJ Arthrography of the shoulder Orthop Clin North Am 1980; 11:205-17
  7. ^ Shaikh, A; Sundaram, M January 2009 "Adhesive capsulitis demonstrated on magnetic resonance imaging" Orthopedics 32 1: 2 PMID 19226048 doi:103928/01477447-20090101-20 
  8. ^ Arend CF Ultrasound of the Shoulder Master Medical Books, 2013 Chapter on ultrasound findings of adhesive capsulitis available at ShoulderUScom
  9. ^ a b c d Ewald, A 2011 "Adhesive capsulitis: A review" American family physician 83 4: 417–422 PMID 21322517 
  10. ^ Tveitå, Einar Kristian; Tariq, Rana; Sesseng, Solve; Juel, Niels Gunnar; Bautz-Holter, Erik 2008 "Hydrodilatation, corticosteroids and adhesive capsulitis: A randomized controlled trial" BMC Musculoskeletal Disorders 9: 53 PMC 2374785  PMID 18423042 doi:101186/1471-2474-9-53 
  11. ^ Baums, M H; Spahn, G; Nozaki, M; Steckel, H; Schultz, W; Klinger, H-M 2006 "Functional outcome and general health status in patients after arthroscopic release in adhesive capsulitis" Knee Surgery, Sports Traumatology, Arthroscopy 15 5: 638–44 doi:101007/s00167-006-0203-x 
  12. ^ "Questions and Answers about Shoulder Problems" Retrieved 2008-01-28 
  13. ^ Adam, Rocchi 10 May 2016 "Frozen Shoulder – What, Where, Why and How To Get Relief" Spine Scan Spine Scan Retrieved 28 July 2016 

This article contains text from the public domain document "Frozen Shoulder", American Academy of Orthopaedic Surgeons

External linksedit

  • "Frozen Shoulder" from the American Academy of Orthopedic Surgeons
  • Siegel, Lori B; Cohen, Norman J; Gall, Eric P 1999 "Adhesive capsulitis: a sticky issue" American family physician 59 7: 1843–52 PMID 10208704 
  • Radiology image sequence demonstrating CT guided shoulder hydrodilatation
  • "Adhesive Capsulitis" from Arend CF Ultrasound of the Shoulder Master Medical Books, 2013

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