Adhesive Capsulitis of the Shoulder

Abstract

The shoulder joint is susceptible to the development of various conditions that cause damage or inflammation to the joint cartilage, ligaments, tendons, and soft tissues. Although most of these conditions can cause pain and functional disability, a favorable outcome is expected when they are properly managed. In some patients, however, increasing pain and inflammation lead to the development of edema and stiffness of the soft and connective tissues of the shoulder and result in the formation of fibrous adhesions that severely restrict the range of motion of the joint. If this condition is untreated, significant pain and functional disability and ultimately a frozen shoulder can result. This conditions tends to occur more commonly in females and in patients over the age of 40 unless there is a history of antecedent trauma.

Diseases that predispose the patient to the development of adhesive capsulitis can be divided into two general categories: (1) those within the shoulder and proximal upper extremity (e.g., rotator cuff tendinopathy, subdeltoid bursitis, and biceps tendon tendinopathy) and (2) diseases outside the shoulder region (e.g., stroke, diabetes, myocardial infarction, tuberculosis, Parkinson’s disease, and reflex sympathetic dystrophy).

Keywords

adhesive capsulitis, shoulder pain, frozen shoulder, intra-articular injection shoulder, ultrasound guided injected, villonodular synovitis, Lyme disease

ICD-10 CODE M75.00

The Clinical Syndrome

The shoulder joint is susceptible to the development of various conditions that cause damage or inflammation to the joint cartilage, ligaments, tendons, and soft tissues. Although most of these conditions can cause pain and functional disability, a favorable outcome is expected when they are properly managed. In some patients, however, increasing pain and inflammation lead to the development of edema and stiffness of the soft and connective tissues of the shoulder and result in the formation of fibrous adhesions that severely restrict the range of motion of the joint. If this condition is untreated, significant pain and functional disability and ultimately a frozen shoulder can result. This condition tends to occur more commonly in females and in patients over the age of 40 unless there is a history of antecedent trauma.

Diseases that predispose the patient to the development of adhesive capsulitis can be divided into two general categories: (1) those within the shoulder and proximal upper extremity (e.g., rotator cuff tendinopathy, subdeltoid bursitis, and biceps tendon tendinopathy) and (2) diseases outside the shoulder region (e.g., stroke, diabetes, myocardial infarction, tuberculosis, Parkinson’s disease, and reflex sympathetic dystrophy).

Regardless of the underlying cause of adhesive capsulitis, failure of prompt diagnosis and treatment of this condition uniformly results in a poor clinical outcome.

Signs and Symptoms

Most patients presenting with shoulder pain secondary to adhesive capsulitis complain of pain that is localized around the shoulder and upper arm. Activity makes the pain worse, whereas rest and heat provide some relief. The pain is constant and is characterized as aching; it may interfere with sleep. Some patients complain of a grating or popping sensation with use of the joint, and crepitus may be present on physical examination.

In addition to pain, patients suffering from adhesive capsulitis of the shoulder joint often experience a gradual reduction in functional ability because of decreasing shoulder range of motion that makes simple everyday tasks, such as combing one’s hair, fastening a brassiere, or reaching overhead, quite difficult ( Fig. 30.1 ). With continued disuse, muscle wasting may occur, and a frozen shoulder may develop. Sleep disturbance is quite common in patients suffering from adhesive capsulitis and may further exacerbate the patient’s pain.

Testing

Plain radiographs are indicated in all patients who are suspected of suffering from adhesive capsulitis, to rule out other causes of shoulder pain. Based on the patient’s clinical presentation, additional testing may be indicated, including a complete blood count, erythrocyte sedimentation rate, and antinuclear antibody testing. Magnetic resonance imaging of the shoulder is indicated to identify treatable shoulder abnormalities (e.g., rotator cuff tears), as well as to define the extent of adhesive capsulitis ( Figs. 30.2 and 30.3 ). Radionuclide bone scanning is indicated if metastatic disease or primary tumor involving the shoulder is a possibility. Diseases outside the shoulder region may cause shoulder pain (e.g., pericarditis, hypothyroidism, and reflex sympathetic dystrophy), and specific testing to rule out these disorders is mandatory if successful diagnosis and treatment are to be expected.