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:

Clinical Features

  • Stage 1 (first 2-3mo)
    • Acute synovial inflammation with limitation of shoulder movement due to pain
  • Stage 2 (months 3-9)
    • "Freezing stage"
      • Decreased shoulder motion due to capsular thickening/scarring; patient 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

Evaluation

  • 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

Differential Diagnosis

Shoulder and Upper Arm Diagnoses

Traumatic/Acute:

Nontraumatic/Chronic:

Refered pain & non-orthopedic causes:

Management

  • Avoid immobilization
  • PT
  • 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

  • Refer to primary care for physical therapy

References

  1. 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.
  2. 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.