Adhesive capsulitis

• Adhesive capsulitis:

  • Also called frozen shoulder
  • Relatively common cause of shoulder pain and stiffness - can significantly impair activities
  • Most commonly affects people in middle age
  • Diabetes is key risk factor - glycosylation of the capsule
• Can be:

  • Primary- occurring spontaneously without any trigger
  • Secondary - occurring in response to trauma, surgery or immobilisation
• Pathophysiology:

  • The glenohumeral joint is surrounded by connective tissue that forms the joint capsule
  • In adhesive capsulitis, inflammation and fibrosis in the joint capsule lead to adhesions
  • The adhesions bind the capsule and cause it to tighten around the joint, restricting movement
• Typical course of symptoms with three phases:

  • Painful phase - shoulder pain is often the first symptoms and may be worse at night
  • Stiff phase - shoulder stiffness develops and affects both active and passive movement (external rotation is most affected) - pain settles during this phase
  • Thawing phase - gradual improvement in stiffness and a return to normal
• The entire illness last 1-3 years before resolving e.g. 6 months in each phase

  A large number of patients (up to 50%) have persistent symptoms
• Diagnosis:

  • Clinical diagnosis based on history and examination - whole joint may be tender to palpation and inability to do passive external rotation
  • Exclude other causes of pain and stiffness:
  • X-ray usually normal
  • USS, CT or MRI scans can show a thickened joint capsule
• Non-surgical management:

  • Continue using arm, but don't exacerbate pain
  • Physiotherapy
  • Analgesia - NSAIDs
  • Intra-articular steroid injections (short term pain relief usually 6 weeks)
  • Hydrodilation - inject mixture of saline, steroids and local anaesthetic into joint to stretch capsule
• Surgical management:

  • Manipulation under anaesthesia - forcefully stretching the capsule to improve the range of motion
  • Arthroscopy - keyhole surgery to cut adhesions and release the shoulder
• Tailor treatment to stage of condition:

  • Painful phase - NSAIDs, physiotherapy, steroid injections
  • Stiff phase - aggressive stretching exercises are the focus to regain range of motion