Adhesive capsulitis

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

• Stage 1 (first 2-3mo)
  • Acute synovial inflammation w/ limitation of shoulder movement due to pain
• Stage 2 (months 3-9)
  • "Freezing stage"
    • Decreased shoulder motion due to capsular thickening/scarring; pt has chronic pain
• Stage 3 (months 9-15)
  • "Frozen stage"
    • Less pain, but significantly decreased range of motion
• Stage 4 (months >15)
  • Minimal pain, progressive improvement in shoulder range of motion

Diagnosis

• Hallmark is limited active and passive range of motion
• Pain
  • Diffuse, aching, poorly localized, accompanied by stiffness, worse at night
  • Not typically reproducible by palpation

Treatment

1. Avoid immobilization
2. Analgesia
   1. NSAIDs, opioids
3. Oral steroids
   1. Provide significant short-term benefit in terms of relieving pain and improving ROM

Disposition

• Refer to PMD for physical therapy

Source

• Tintinalli