Frozen Shoulder
Original Editors - Nina Lefeber
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Search Strategy[edit | edit source]
To search for information about adhesive capsulitis, medical databases, such as Pubmed and PEDro, were used. Keywords I used to find information are adhesive capsulitis, frozen shoulder, treatment AND adhesive capsulitis, exercises AND adhesive capsulitis.
Definition/Description[edit | edit source]
Adhesive capsulitis, or frozen shoulder, is a condtion in which the capsule of the glenohumeral joint is inflamed. It is characterized by a painful, gradual loss of both active and passive glenohumeral motion, resulting from progressive fibrosis and contracture of the glenohumeral joint capsule. [1] [2] Contracture is defined as shortening of connective tissue (ligaments, tendons, and cartilage) and caused by excessive arthrofibrosis, immobilization, inactivation and adhesions.[3]
Adhesive capsulitis is described as being either primary or secondary. Primary, or idiopathic, adhesive capsulitis is due to an unknown cause, whereas secondary adhesive capsulitis results from a known cause or surgical event. [4]
Clinically Relevant Anatomy[edit | edit source]
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Epidemiology /Etiology[edit | edit source]
Adhesive capsulitis occurs in 2% to 5% of the population. The majority of patients are female, and especially between the ages of 40 to 60 years. [1][2] The non-dominant hand is more frequently involved, and about 20% to 30% of those affected will develop the condition in the opposite shoulder.
The causes remain unclear. Twenty percent to 30% of patients will report a history of minor trauma to the shoulder, but there is no further evidence that this is a posttraumatic condition. Others develop this condition due to an unknown cause.
The development of adhesive capsulitis has been associated with diabetes mellitus, thyroid dysfunction, Dupuytrens contractures, autoimmune disease, and the treatment of breast cancer. Patients with cerebrovascular accident or myocardial infarction have been reported to be at increased risk. In general, it’s more common in those with sedentary vocations than in manual laborers. [1]
Characteristics/Clinical Presentation[edit | edit source]
Idiopathic adhesive capsulitis is characterized by multiple stages. Many scientists describe 3 clinical phases: the painful stage, the frozen or adhesive stage and the thawing or regressive stage.[5][6] Neviaser and Neviaser divided this first phase into two separate phases.[1] The difference between phase 1 and 2 is not very explicit, but an intra-articular anesthetic injection can be used to discriminate between these stages. In stage 1, motion can be fully restored, when pain is relieved by an intra-articular anesthetic injection, whereas in stage 2 the limitation cannot be fully restored.
Stage 1 is characterized by a gradual onset of pain typically referred to the deltoid insertion. Pain is the main initial complaint. It is usually achy at rest and sharper with movement. Patients often report pain at night and an inability to sleep on the affected side. During examination, an empty end feel at the extremes of motion can be observed. Forward flexion, abduction and rotation may worsen the pain. Patients can also indicate limited motion. In this stage, duration of symptoms is generally less than 3 months. [1]
Stage 2 represents a combination of acute synovitis and progressive capsular contracture. Pain persists and may be more severe. Motion is restricted in forward flexion, abduction, and internal and external rotation. Duration of symptoms can range from 3 to 9 months. [1]
In stage 3, the frozen stage, the main complaint is significant stiffness with decreased range of motion. Pain may still be present at the end range of motion and occasionally at night. Physical examination reveals a sense of mechanical block or tethering at the ends of motion. Symptoms have typically been present for 9 to 15 months at this point. [1]
Stage 4, the chronic stage, has also been termed the thawing stage. Pain is minimal, and a gradual improvement in motion can occur.[1] This stage typically lasts 15 to 24 months. [7]
Also it is not unusual for a patient to develop a frozen shoulder on the opposite side after the original condition has improved.[1]
Differential Diagnosis[edit | edit source]
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Diagnostic Procedures[edit | edit source]
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Outcome Measures[edit | edit source]
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Examination[edit | edit source]
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Medical Management
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Physical Therapy Management
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Key Research[edit | edit source]
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Clinical Bottom Line[edit | edit source]
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Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
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- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 Andrew S. Neviaser, MD, and Jo A. Hannafin, MD, PhD, Adhesive Capsulitis: A Review of Current Treatment, The American Journal of Sports Medicine, 2010 Nov; 38 (11): 2346-56. Epub 2010 Jan 28. Level of evidence A1.
- ↑ 2.0 2.1 Walmsley S, Rivett DA, Osmotherly PG., Adhesive capsulitis: establishing consensus on clinical identifiers for stage 1 using the DELPHI technique., Phys Ther. 2009 Sep;89(9):906-17. Epub 2009 Jul 9. Level of evidence B.
- ↑ Gaspar PD, Willis FB, Adhesive capsulitis and dynamic splinting: a controlled, cohort study, BMC Musculoskelet Disorders, 2009 Sep 7;10:111. Level of evidence B.
- ↑ Sam W. Wiesel, John N. Delahay, Essentials of Orthopedic Surgery. 4th Edition, 2010, Springer Science+Business Media LLC, NY (USA).
- ↑ Guler-Uysal F, Kozanoglu E. , Comparison of the Early Response to Two Methods of Rehabilitation in Adhesive Capsulitis, Swiss Medicine Weekly. 2004 Jun 12; 134(23-24):353-8. Level of evidence A2.
- ↑ H.A. Anton, MD, FRCPC, Frozen Shoulder, Canadian Family Physician, 1993 August; 39: 1773–1778.
- ↑ Kelley MJ, McClure PW, Leggin BG., Frozen shoulder: evidence and a proposed model guiding rehabilitation, Journal of Orthopedics & Sports Physical Therapy. 2009 Feb;39(2):135-48. Level of evidence D.
