Adhesive capsulitis: Difference between revisions
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==Background== | ==Background== | ||
[[File:Gray326.png|thumb|Shoulder anatomy]] | |||
[[File:Shoulder_joint_back-en.png|thumb|Shoulder anatomy, anterior.]] | |||
[[File:Shoulder joint back 05r4v.png|thumb|Shoulder anatomy, posterior.]] | |||
*Also known as "frozen shoulder syndrome" | *Also known as "frozen shoulder syndrome" | ||
*Inflammation of glenohumeral joint → joint capsule fibrosis, shoulder restriction | *Inflammation of glenohumeral joint → joint capsule fibrosis, shoulder restriction | ||
*Must rule-out posterior shoulder dislocation | *Must rule-out [[posterior shoulder dislocation]] | ||
*Associated with: | *Associated with: | ||
**[[Impingement Syndrome]] | **[[Impingement Syndrome]] | ||
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**Not typically reproducible by palpation | **Not typically reproducible by palpation | ||
{| class="wikitable" | |||
! Stage !! Category !! Timeline (months) !! Findings | |||
|- | |||
| 1 || Acute || 2-3 || Acute synovial inflammation with limitation of shoulder movement due to pain | |||
|- | |||
| 2 || Freezing || 3-9 || Decreased shoulder motion due to capsular thickening/scarring; patient has chronic pain | |||
|- | |||
| 3 || Frozen || 9-15 || Less pain, but significantly decreased range of motion | |||
|- | |||
| 4 || Chronic || >15 || Minimal pain, progressive improvement in shoulder range of motion | |||
|} | |||
==Evaluation== | ==Evaluation== | ||
*Clinical diagnosis, consider X-ray to rule out fracture/dislocation | *Clinical diagnosis, consider X-ray to rule out [[fracture]]/[[shoulder dislocation|dislocation]] | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Management== | ==Management== | ||
[[File:MRI. Thickened joint capsule, specially at the inferior recess. Could be a sign for a frozen shoulder..jpg|thumb|Shoulder MRI showing a thickened joint capsule, especially at the inferior recess, which can be a sign of adhesive capsulitis.]] | |||
*Avoid immobilization | *Avoid immobilization | ||
* | *Physical therapy | ||
*[[Analgesia]] | *[[Analgesia]] | ||
**[[NSAIDs]], [[opioids]] | **[[NSAIDs]], [[opioids]] | ||
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==Disposition== | ==Disposition== | ||
*Discharge, refer to primary care/ortho for physical therapy | *Discharge, refer to primary care/ortho for physical therapy | ||
==See Also== | |||
*[[Shoulder diagnoses]] | |||
==External Links== | |||
==References== | ==References== | ||
Latest revision as of 17:02, 19 March 2025
Background
- Also known as "frozen shoulder syndrome"
- Inflammation of glenohumeral joint → joint capsule fibrosis, shoulder restriction
- Must rule-out posterior shoulder dislocation
- Associated with:
- Impingement Syndrome
- Postmenopause
- DM
- Thyroid disease
- Pulmonary neoplasm
- Autoimmune
Clinical Features
- Hallmark is limited active and passive range of motion
- Shoulder pain
- Diffuse, aching, poorly localized, accompanied by stiffness, worse at night
- Not typically reproducible by palpation
| Stage | Category | Timeline (months) | Findings |
|---|---|---|---|
| 1 | Acute | 2-3 | Acute synovial inflammation with limitation of shoulder movement due to pain |
| 2 | Freezing | 3-9 | Decreased shoulder motion due to capsular thickening/scarring; patient has chronic pain |
| 3 | Frozen | 9-15 | Less pain, but significantly decreased range of motion |
| 4 | Chronic | >15 | Minimal pain, progressive improvement in shoulder range of motion |
Evaluation
- Clinical diagnosis, consider X-ray to rule out fracture/dislocation
Differential Diagnosis
Shoulder and Upper Arm Diagnoses
Traumatic/Acute:
- Shoulder Dislocation
- Clavicle fracture
- Humerus fracture
- Scapula fracture
- Acromioclavicular joint injury
- Glenohumeral instability
- Rotator cuff tear
- Biceps tendon rupture
- Triceps tendon rupture
- Septic joint
Nontraumatic/Chronic:
- Rotator cuff tear
- Impingement syndrome
- Calcific tendinitis
- Adhesive capsulitis
- Biceps tendinitis
- Subacromial bursitis
- Cervical radiculopathy
Refered pain & non-orthopedic causes:
- Referred pain from
- Neck
- Diaphragm (e.g. gallbladder disease)
- Brachial plexus injury
- Axillary artery thrombosis
- Thoracic outlet syndrome
- Subclavian steal syndrome
- Pancoast tumor
- Myocardial infarction
- Pneumonia
- Pulmonary embolism
Management
- Avoid immobilization
- Physical therapy
- Analgesia
- Oral steroids
- Provide significant short-term benefit in terms of relieving pain and improving ROM
- Intra-articular steroids (20-40mg triamcinolone)
- Benefits last a few months, possibly up to 6 months[1]
- Joint distention
- Intra-articular distention with 25-40mL of saline + anesthetic is as effective as IA steroids[2]
Disposition
- Discharge, refer to primary care/ortho for physical therapy
See Also
External Links
References
- ↑ Sun Y, Zhang P, Liu S, et al. Intra-articular Steroid Injection for Frozen Shoulder: A Systematic Review and Meta-analysis of Randomized Controlled Trials With Trial Sequential Analysis. Am J Sports Med. 2017;45(9):2171-2179.
- ↑ Lin MT, Hsiao MY, Tu YK, Wang TG. Comparative Efficacy of Intra-Articular Steroid Injection and Distension in Patients With Frozen Shoulder: A Systematic Review and Network Meta-Analysis. Arch Phys Med Rehabil. 2018;99(7):1383-1394.e6.