Adhesive capsulitis (frozen shoulder)

Question 1

Define adhesive capsulitis.

Answer 1

A chronic fibrosing condition characterised by insidious and progressive severe restriction of both active and passive shoulder range of motion, in the absence of a known intrinsic disorder of the shoulder.

Question 2

What is the general prognosis with adhesive capsulitis?

Answer 2

It is generally regarded as a self-limiting condition that usually resolves within 18 to 24 months.

Pain is the main problem initially. It can be worse in bed and disturb sleep.

The pain gradually improves, but stiffness slowly worsens and becomes the main problem. The stiffness then gradually resolves.

Frozen shoulder is usually self-limiting, but it can take months to years to resolve.

Question 3

What are the risk factors for adhesive capsulitis?

Answer 3

• 40-70yrs old
• DM - up to 25% of those affected have diabetes
• Previous history
• Shoulder pain and immobilisation
• Shoulder surgery in the past

Question 4

What is the pathophysiology of adhesive capsulitis?

Answer 4

Poorly understood

Question 5

What are the clinical features of adhesive capsulitis?

Answer 5

• Stiffness +/- pain in shoulder
• Decreased active and passive range of motion - should be examined supine so that the scapula is locked in. External rotation is affected more than internal rotation or abduction.
• Positive coracoid pain test -highly sensitive and specific
• Positive shoulder shrug test - not very specific

Patients typically have a painful freezing phase, an adhesive phase and a recovery phase

Question 6

How commonly is adhesive capsulitis bilateral?

Answer 6

20%

Question 7

How long does adhesive capsulitis usually last?

Answer 7

6months to 2 years

Question 8

How is adhesive capsulitis diagnosed?

Answer 8

Usually clinically. Helpful investigations include:

Ultrasound is imaging of choice to confirm diagnosis - shows thickening of the coracohumeral ligament and the soft-tissue structures

Question 9

When is pain worst in adhesive capsulitis?

Answer 9

Usually worst at night and disrupts sleep

Question 10

What is the management of adhesive capsulitis?

Answer 10

• Activity modification and pain control - encourage movement of the arm to ease spasm. Support arm with pillows in bed and do not sleep on that side.
• Physio - 6 weeks
• Glenohumeral corticosteroid injection

Refer if this does not help or if pain/stiffness lasts over 3 months.