Adhesive Capsulitis

Adhesive capsulitis (frozen shoulder) is a common cause of shoulder pain. It is most common in middle-aged females. The aetiology of frozen shoulder is not fully understood.

Associations

Adhesive capsulitis is due to chronic inflammation, fibrosis, and contracture of the joint capsule. It can be idiopathic or secondary to rotator cuff tendinopathy, subacromial bursitis, paralytic stroke, diabetes, or humeral head fracture.
Up to 20% of diabetics may have an episode of frozen shoulder

Features typically develop over days

external rotation is affected more than internal rotation or abduction
both active and passive movement is affected
patients typically have a painful freezing phase, an adhesive phase and a recovery phase
bilateral in up to 20% of patients
the episode typically lasts between 6 months and 2 years

The diagnosis is usually clinical although imaging may be required for atypical or persistent symptoms.

Management

no single intervention has been shown to improve outcome in the long-term
treatment options include NSAIDs, physiotherapy, oral corticosteroids and intra-articular corticosteroids

Patients have should stiffness with a reduction of both passive and active range of motion.