Adhesive capsulitis of shoulder

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Template:Adhesive Capsulitis of Shoulder Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Marufa Marium, M.B.B.S[2]

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Synonyms and Keywords: Frozen shoulder syndrome; Adhesive capsulitis; Duplay Bursitis, Scapulohumeral periarthritis; Arthofibrosis; Shoulder pain; Shoulder stiffness; Shoulder Capsulitis.

Overview

Adhesive capsulitis is an inflammatory insult to glenohumeral joint limiting range of motion actively and passively due to pain and stiffness of shoulder joint. The range of motion is debilitated due to inflammation and fibrosis of adhesive bursa due to primary and secondary causes.

Historical Perspective

Classification

Pathophysiology

Causes

Adhesive Capsulitis may be caused by primarily or Secondarily. Diabetes Mellitus is most common cause of adhesive capsulitis among the secondary cause. The etiologies are:

Differentiating Adhesive capsulitis from other Diseases

For further information about the differential diagnosis, click here.

Epidemiology and Demographics

Age

Gender

Race

  • People from African American and Hispanic or Latino race are more likely to have association with Adhesive capsulitis.[17]

Risk Factors

Natural History, Complications and Prognosis

  • Adhesive capsulitis has clinical features occurring in three distinctive phases. Phases are elaborated below[18][1]:
    • Stage 1 or Inflammatory phase or Painful phase: Acute onset of pain with minimal limitation of joint in first three months of frozen shoulder.
    • Stage 2 or Synovial proliferation phase or Freezing phase: from three to nine months there may be pain with severe intensity with decreased range of active and passive motion.
    • Stage 3 or Maturation phase with collagenous tissue deposition or Frozen or transitional phase: Marked stiffness with decreased natural swinging of upper extremity in next ninth to fourteenth month of diagnosis.
    • Stage 4 or Chronic phase or Thawing phase: Frozen shoulder may resolve spontaneously, thus R j Neviaser and T J Neviaser called it thawing phase, but in recent studies it was shown that it may persist as chronic phase.
  • If left untreated, Adhesive capsulitis may progress to develop in contralateral shoulder.
  • Common complications of adhesive capsulitis include pain and stiffness for long duration, Bicep tendon rupture, Humeral bone fracture.
  • Prognosis is generally good and it may resolved within one to three years spontaneously or if treatment is given early with capsulotomy.

Diagnosis

Diagnostic Criteria

  • The diagnosis of adhesive capsulitis is a diagnosis of exclusion and is made when the following diagnostic criteria are met after evaluating four components according to the Orthopedic department of the APTA's recent guideline: [19]:

Symptoms

  • Diffuse Pain and stiffness of shoulder
  • Loss of range of motion actively and passively with limited overhead activity
  • Loss of natural swing of arm
  • Weakness of affected upper extremity
  • Adhesive capsulitis has clinical features occurring in three distinctive phases. Phases are elaborated below[18][1]:
    • Stage 1 or Inflammatory phase or Painful phase: Acute onset of pain with minimal limitation of joint in first three months of frozen shoulder.
    • Stage 2 or Synovial proliferation phase or Freezing phase: from three to nine months there may be pain with severe intensity with decreased range of active and passive motion.
    • Stage 3 or Maturation phase with collagenous tissue deposition or Frozen or transitional phase: Marked stiffness with decreased natural swinging of upper extremity in next ninth to fourteenth month of diagnosis.
    • Stage 4 or Chronic phase or Thawing phase: Frozen shoulder may resolve spontaneously, thus R j Neviaser and T J Neviaser called it thawing phase, but in recent studies it was shown that it may persist as chronic phase.

Physical Examination

Laboratory Findings

Electrocardiogram

There are no ECG findings associated with adhesive capsulitis.

X-ray

An x-ray might be helpful in aiding to diagnose chronic case of Adhesive capsulitis and to rule out other causes of stiff shoulder. Findings on an x-ray suggestive of chronic adhesive capsulitis include disuse osteopenia [20].

Echocardiography or Ultrasound

Musculoskeletal ultrasound may be helpful in the diagnosis of adhesive capsulitis. Findings on an MSK ultrasound diagnostic of adhesive capsulitis include thick coracohumeral ligament, fluid effusion surrounding tendon from long head of biceps.

CT scan

Coronal oblique CT arthrography scan may be helpful in the diagnosis of adhesive capsulitis. Findings on CT scan suggestive of adhesive capsulitis include thick synovial capsule, resorption of subchondral humeral head, thin recess in axilla[21].

MRI

Shoulder MRI and MRA may be helpful in the diagnosis of adhesive capsulitis. Findings on MRI and MRA diagnostic of adhesive capsulitis include decreased rotator interval(RI), enhancement of rotator interval, dysfunctional tissue, thickening of capsules and coracohumeral ligament, axillary recess volume depletion, axillary recess width reduction, T2 MRI showing enhancement of glenohumeral ligament inferiorly[21][22].

Other Imaging Findings

Bone scan with technetium-99m contrast may be helpful in the diagnosis of adhesive capsulitis. Findings on an Bone scan with technetium-99m contrast suggestive of/diagnostic of adhesive capsulitis include 2% uptake in affected part[2].

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Prevention

Related Chapters

References

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  8. 8.0 8.1 8.2 8.3 Hand GC, Athanasou NA, Matthews T, Carr AJ (July 2007). "The pathology of frozen shoulder". J Bone Joint Surg Br. 89 (7): 928–32. doi:10.1302/0301-620X.89B7.19097. PMID 17673588.
  9. Kim YS, Kim JM, Lee YG, Hong OK, Kwon HS, Ji JH (February 2013). "Intercellular adhesion molecule-1 (ICAM-1, CD54) is increased in adhesive capsulitis". J Bone Joint Surg Am. 95 (4): e181–8. doi:10.2106/JBJS.K.00525. PMID 23426775.
  10. Raykha CN, Crawford JD, Burry AF, Drosdowech DS, Faber KJ, Gan BS, O'Gorman DB (August 2014). "IGF2 expression and β-catenin levels are increased in Frozen Shoulder Syndrome". Clin Invest Med. 37 (4): E262–7. doi:10.25011/cim.v37i4.21733. PMID 25090267.
  11. Kanbe K, Inoue K, Inoue Y, Chen Q (January 2009). "Inducement of mitogen-activated protein kinases in frozen shoulders". J Orthop Sci. 14 (1): 56–61. doi:10.1007/s00776-008-1295-6. PMC 2893737. PMID 19214689.
  12. Xu Y, Bonar F, Murrell GA (October 2012). "Enhanced expression of neuronal proteins in idiopathic frozen shoulder". J Shoulder Elbow Surg. 21 (10): 1391–7. doi:10.1016/j.jse.2011.08.046. PMID 22005128.
  13. Watson RS, Gouze E, Levings PP, Bush ML, Kay JD, Jorgensen MS, Dacanay EA, Reith JW, Wright TW, Ghivizzani SC (November 2010). "Gene delivery of TGF-β1 induces arthrofibrosis and chondrometaplasia of synovium in vivo". Lab Invest. 90 (11): 1615–27. doi:10.1038/labinvest.2010.145. PMC 3724510. PMID 20697373.
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  19. "www.orthopt.org" (PDF).
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