Updated: 12/27/2021

Adhesive Capsulitis

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  • Snapshot
    • A 52-year-old woman with a past medical history of diabetes presents with prolonged shoulder pain and stiffness. For the past few months, she reports persistent left shoulder pain that also occurs at night. She denies any inciting trauma. On physical exam, she has decreased active and passive range of motion. She is also unable to reach 90° with passive abduction. She is sent home with range of motion exercises and counseled that this will likely resolve with time.
  • Introduction
    • Clinical definition
      • a condition of the shoulder characterized by severely limited range of motion
        • also known as "frozen shoulder"
  • Epidemiology
    • Demographics
      • female > male
      • > 40 years of age
    • Risk factors
      • diabetes
  • Etiology
    • Pathogenesis
      • inflammation of the capsule may lead to increased adhesions and fibrosis, resulting in limited range of motion
    • Associated conditions
      • diabetes mellitus
      • thyroid disease
      • trauma
      • scleroderma
      • Dupuytren disease
  • Presentation
    • Symptoms
      • insidious onset of shoulder stiffness and pain at rest and with movement
      • limited range of motion
    • Physical exam
      • non-dominant shoulder > dominant shoulder
      • diffuse tenderness to palpation over the shoulder, without focal tenderness
      • may have atrophy of shoulder muscles
      • limited range of active and passive motion compared with contralateral shoulder
        • inability to reach 90° with passive abduction
  • Imaging
    • Radiography
      • indication
        • not routinely indicated unless there is suspicion for other pathologies
      • findings
        • usually normal
        • may reveal osteoarthritis instead of adhesive capsulitis
  • Studies
    • Making the diagnosis
      • most cases are clinically diagnosed with inability to reach 90° with passive abduction
  • Differential
    • Osteoarthritis of shoulder
      • distinguishing factor
        • radiography demonstrates osteoarthritis
    • Rotator cuff tendinopathy
      • distinguishing factor
        • focal tenderness at the subacromial point
    • Scleroderma
      • distinguishing factor
        • skin thickening
  • Treatment
    • Conservative
      • range of motion exercises and physical therapy
        • indication
          • used for all patients
            • progressive activity is typically recommended
    • Medical
      • nonsteroidal anti-inflammatory drugs (NSAIDs)
        • indication
          • pain management
  • Complications
    • Persistent pain and stiffness
  • Prognosis
    • Typically resolves over 1-3 years
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