Adhesive capsulitis

Background

Shoulder anatomy
Shoulder anatomy, anterior.
Shoulder anatomy, posterior.

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

Differential Diagnosis

Shoulder and Upper Arm Diagnoses

Traumatic/Acute:

Nontraumatic/Chronic:

Refered pain & non-orthopedic causes:

Management

Shoulder MRI showing a thickened joint capsule, especially at the inferior recess, which can be a sign of adhesive capsulitis.
  • 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

  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.