Adhesive capsulitis
Adhesive capsulitis (frozen shoulder) is progressive fibrotic thickening of the glenohumeral joint capsule causing global loss of active and passive range of motion. It is a clinical diagnosis treated with range-of-motion physical therapy, analgesia, and intra-articular glucocorticoid injection, with capsular release reserved for cases that fail 3 to 6 months of conservative care.
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What this article covers
- Overview
Progressive capsular fibrosis: adhesive capsulitis ("frozen shoulder") is a disorder of the glenohumeral joint in which progressive thickening and fibrosis of the joint capsule cause the shoulder to lose its normal range of motion.
- Epidemiology
Age band: adhesive capsulitis usually occurs in patients aged 40 to 70 years and is uncommon outside middle age and later life.
- Risk factors
Diabetes mellitus: the single most consistently cited predisposing systemic disease.
- Pathophysiology
Capsular thickening and fibrosis: the disorder is secondary to progressive thickening of the glenohumeral joint capsule, which contracts around the humeral head and mechanically restricts glenohumeral motion in all planes.
- Clinical features
Global active and passive range-of-motion loss in a patient aged 40 to 70: this is the defining clinical pattern; demonstrating restricted motion in multiple planes on both active effort and passive…
- Differential diagnosis
Rotator cuff tendinitis or tear: presents with anterolateral or lateral deltoid pain and weakness with a positive drop-arm test, but active motion is disproportionately limited compared with passive…
- Diagnosis
Clinical diagnosis by demonstrated motion loss: adhesive capsulitis is diagnosed clinically, based on demonstrating both active and passive shoulder mobility reduction in multiple planes on…
- Management
First, start range-of-motion physical therapy: most cases are managed initially with structured range-of-motion exercises and physical therapy aimed at restoring passive and active motion.
- Complications
Persistent stiffness and functional limitation: some patients do not regain full range of motion even one to three years after symptom onset.
- Prognosis
Generally self-limited: frozen shoulder is often a self-limiting condition, but the natural course is prolonged.
- Prevention
Avoid prolonged shoulder immobilization after injury or surgery: immobilization with a sling should specifically be avoided after rotator cuff injury and other shoulder trauma to prevent development…
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