Adhesive capsulitis of shoulder

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Adhesive capsulitis of the shoulder
Other namesFrozen shoulder
Gray327.png
The right shoulder & glenohumeral joint.
Specialty Orthopedics
SymptomsPain, stiffness, restricted movement [1]

Adhesive capsulitis, also known as frozen shoulder, is a condition associated with shoulder joint pain and stiffness. There is loss of both passive and active range of motion and shoulder movement is extremely painful. The pain and stiffness can impact daily life activities but tend to improve over time. It can be diagnosed by history and physical exam.

Contents

The cause of frozen shoulder is not completely understood. The condition can occur after injury or surgery to the shoulder (secondary) or may develop with no trigger (primary or idiopathic). Risk factors for frozen shoulder include diabetes mellitus, stroke, lung disease, connective tissue diseases, thyroid disease, and heart disease. It is more common in people 40–65 years of age and in women. [1]

The condition tends to be self-limiting and usually resolves over time without intervention but may take several years. Treatments can include physical therapy, occupational therapy, joint injections, massage therapy, hydrodilatation or surgery. Pain and inflammation can be controlled with pain medications such as NSAIDs.

Signs and symptoms

Symptoms include shoulder pain and limited range of motion although these symptoms are common in many shoulder conditions. An important symptom of adhesive capsulitis is the severity of stiffness that often makes it nearly impossible to carry out simple arm movements. Pain due to frozen shoulder is usually dull or aching and may be worse at night and with any motion.

The symptoms of primary frozen shoulder has been described as having three [2] or four stages. [1] Sometimes a prodromal stage is described that can be present up to three months prior to the shoulder freezing. During this stage people describe sharp pain at end ranges of motion, achy pain at rest, and sleep disturbances.

Physical exam findings include restricted range of motion in all planes of movement in both active and passive range of motion. [5] This contrasts with conditions such as shoulder impingement syndrome or rotator cuff tendinitis in which the active range of motion is restricted but passive range of motion is normal. Some exam maneuvers of the shoulder may be impossible due to pain.

Causes

The causes of adhesive capsulitis are incompletely understood, however there are several factors associated with higher risk. Risk factors for secondary adhesive capsulitis include injury or surgery that lead to prolonged immobility. Risk factors for primary, or idiopathic adhesive capsulitis include many systemic diseases such as diabetes mellitus, stroke, lung disease, connective tissue diseases, thyroid disease, heart disease, autoimmune disease, and Dupuytren's contracture. [6] Both type 1 diabetes and type 2 diabetes are risk factors for the condition. [6]

Primary

Primary adhesive capsulitis, also known as idiopathic adhesive capsulitis occurs with no known trigger. It is more likely to develop in the non-dominant arm.

Secondary

Secondary adhesive capsulitis develops after an injury or surgery to the shoulder.

Pathophysiology

The underlying pathophysiology is incompletely understood but is generally accepted to have both inflammatory and fibrotic components. The hardening of the shoulder joint capsule is central to the disease process. This is the result of scar tissue (adhesions) around the joint capsule. [6] There also may be reduction in synovial fluid, which normally helps the shoulder joint, a ball and socket joint, move by lubricating the gap between the humerus (upper arm bone) and the socket in the shoulder blade. In the painful stage (stage I), there is evidence of inflammatory cytokines in the joint fluid. Later stages are characterized by dense collagenous tissue in the joint capsule. [6]

Diagnosis

Adhesive capsulitis can be diagnosed by history and physical exam. It is often a diagnosis of exclusion as other causes of shoulder pain and stiffness must first be ruled out. On physical exam, adhesive capsulitis can be diagnosed if limits of the active range of motion are the same or similar to the limits to the passive range of motion. The movement that is most severely inhibited is external rotation of the shoulder.

Imaging studies are not required for diagnosis but may be used to rule out other causes of pain. Radiographs are often normal but imaging features of adhesive capsulitis can be seen on ultrasound or non-contrast MRI. Ultrasound and MRI can help in diagnosis by assessing the coracohumeral ligament, with a width of greater than 3 mm being 60% sensitive and 95% specific for the diagnosis. Shoulders with adhesive capsulitis also characteristically fibrose and thicken at the axillary pouch and rotator interval, best seen as dark signal on T1 sequences with edema and inflammation on T2 sequences. [7] A finding on ultrasound associated with adhesive capsulitis is hypoechoic material surrounding the long head of the biceps tendon at the rotator interval, reflecting fibrosis. In the painful stage, such hypoechoic material may demonstrate increased vascularity with Doppler ultrasound. [8]

Management

Management of this disorder focuses on restoring joint movement and reducing shoulder pain, involving medications, physical therapy, and/or surgical intervention. Treatment may continue for months; there is no strong evidence to favor any particular approach. [9]

Medications such as NSAIDs can be used for pain control. Corticosteroids are used in some cases either through local injection or systemically. Oral steroids may provide short-term benefits in range of movement and pain but have side effects such as hyperglycemia. [10] Steroid injections compared to physical therapy have similar effect in improving shoulder function and decreasing pain. [11] The benefits of steroid injections appear to be short-term. [12] [13] It is unclear whether ultrasound guided injections can improve pain or function over anatomy-guided injections. [14]

The role for physical therapy in adhesive capsulitis is not settled. Physical therapy is utilized as an initial treatment in adhesive capsulitis or frozen shoulder with the use of range of motion (ROM) exercises and manual therapy techniques of shoulder joint to restore range and function. A low-dose corticosteroid injection and home exercise programs in those with symptoms less than 6 months may be useful. There may be some benefit with manual therapy and stretching as part of a rehabilitation program but due to the time required such use should be carefully considered. [15] Physical therapists may utilize joint mobilizations directly at the glenohumeral joint to decrease pain, increase function, and increase range of motion as another form of treatment. [1] There are some studies that have shown that intensive passive stretching can promote healing. [16] Additional interventions include modalities such as ultrasound, shortwave diathermy, laser therapy and electrical stimulation. [1] [17] Another osteopathic technique used to treat the shoulder is called the Spencer technique. Mobilization techniques and other therapeutic modalities are most commonly used by physical therapist, however there is not strong evidence that these methods can change the course of the disease. [16]

If these measures are unsuccessful, more aggressive interventions such as surgery can be trialed. Manipulation of the shoulder under general anesthesia to break up the adhesions is sometimes used. [9] Hydrodilatation or distension arthrography is controversial. [18] However, some studies show that arthrographic distension may play a positive role in reducing pain and improve range of movement and function. [19] Surgery to cut the adhesions (capsular release) may be indicated in prolonged and severe cases; the procedure is usually performed by arthroscopy. [20] Surgical evaluation of other problems with the shoulder, e.g., subacromial bursitis or rotator cuff tear may be needed. Resistant adhesive capsulitis may respond to open release surgery. This technique allows the surgeon to find and correct the underlying cause of restricted glenohumeral movement such as contracture of coracohumeral ligament and rotator interval. [21] Physical therapy may achieve improved results after surgical procedure and postoperative rehabilitation. [22]

Prognosis

Most cases of adhesive capsulitis are self limiting but may take 1–3 years to fully resolve. Pain and stiffness may not completely resolve as 20-50% of patients may have persistent symptoms. [6]

Epidemiology

Adhesive capsulitis newly affects approximately 0.75% to 5.0% percent of people a year. [23] Rates are higher in people with diabetes (10–46%). [24] Following breast surgery, some known complications include loss of shoulder range of motion (ROM) and reduced functional mobility in the involved arm. [25] Occurrence is rare in children and people under 40 with highest prevalence between 40 and 70 years of age. [9] The condition is more common in women than in men (70% of patients are women aged 40–60). People with diabetes, stroke, lung disease, rheumatoid arthritis, or heart disease are at a higher risk for frozen shoulder. Symptoms in people with diabetes may be more protracted than in the non-diabetic population. [26]

See also

Related Research Articles

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Arthritis is a term often used to mean any disorder that affects joints. Symptoms generally include joint pain and stiffness. Other symptoms may include redness, warmth, swelling, and decreased range of motion of the affected joints. In some types of arthritis, other organs are also affected. Onset can be gradual or sudden.

Rheumatoid arthritis A type of autoimmune arthritis

Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects joints. It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly, the wrist and hands are involved, with the same joints typically involved on both sides of the body. The disease may also affect other parts of the body. This may result in a low red blood cell count, inflammation around the lungs, and inflammation around the heart. Fever and low energy may also be present. Often, symptoms come on gradually over weeks to months.

Rotator cuff

In anatomy, the rotator cuff is a group of muscles and their tendons that act to stabilize the shoulder and allow for its extensive range of motion. Of the seven scapulohumeral muscles, four make up the rotator cuff. The four muscles are the supraspinatus muscle, the infraspinatus muscle, teres minor muscle, and the subscapularis muscle.

Tendinopathy Bruised tendon

Tendinopathy, also known as tendinitis or tendonitis, is a type of tendon disorder that results in pain, swelling, and impaired function. The pain is typically worse with movement. It most commonly occurs around the shoulder, elbow, wrist, hip, knee, or ankle.

Trigger finger disorder of the finger

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Shoulder problem

Shoulder problems including pain, are one of the more common reasons for physician visits for musculoskeletal symptoms. The shoulder is the most movable joint in the body. However, it is an unstable joint because of the range of motion allowed. This instability increases the likelihood of joint injury, often leading to a degenerative process in which tissues break down and no longer function well.

Osteoarthritis Form of arthritis caused by degeneration of joints

Osteoarthritis (OA) is a type of joint disease that results from breakdown of joint cartilage and underlying bone. The most common symptoms are joint pain and stiffness. Usually the symptoms progress slowly over years. Initially they may only occur after exercise, but can become constant over time. Other symptoms may include joint swelling, decreased range of motion, and, when the back is affected, weakness or numbness of the arms and legs. The most commonly involved joints are the two near the ends of the fingers and the joint at the base of the thumbs; the knee and hip joints; and the joints of the neck and lower back. Joints on one side of the body are often more affected than those on the other. The symptoms can interfere with work and normal daily activities. Unlike some other types of arthritis, only the joints, not internal organs, are affected.

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Rotator cuff tear Rotator cuff tear

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Myofascial pain syndrome (MPS), also known as chronic myofascial pain (CMP), is a syndrome characterized by chronic pain in multiple myofascial trigger points ("knots") and fascial constrictions. It can appear in any body part. Symptoms of a myofascial trigger points include: focal point tenderness, reproduction of pain upon trigger point palpation, hardening of the muscle upon trigger point palpation, pseudo-weakness of the involved muscle, referred pain, and limited range of motion following approximately 5 seconds of sustained trigger point pressure.

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Subacromial bursitis

Subacromial bursitis is a condition caused by inflammation of the bursa that separates the superior surface of the supraspinatus tendon from the overlying coraco-acromial ligament, acromion, and coracoid and from the deep surface of the deltoid muscle. The subacromial bursa helps the motion of the supraspinatus tendon of the rotator cuff in activities such as overhead work.

Calcific tendinitis disorder characterized by deposits of hydroxyapatite (a crystalline calcium phosphate) in any tendon of the body

Calcific tendinitis is a form of tendinitis, a disorder characterized by deposits of hydroxyapatite in any tendon of the body, but most commonly in the tendons of the rotator cuff (shoulder), causing pain and inflammation. The condition is related to and may cause adhesive capsulitis.

Radiculopathy Human disease

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Arthrofibrosis has been described in most joints like knee, hip, ankle, foot joints, shoulder, elbow, wrist, hand joints as well as spinal vertebrae. In the knee, it can happen after knee injury or surgery. There is excessive scar tissue formation within the joint and surrounding soft tissues leading to painful restriction of joint motion that persists despite physical therapy and rehabilitation. The scar tissue can involve only a part of the knee joint or the whole knee. The scar tissue may be located inside the knee joint or may involve the soft tissue structures around the knee joint. Arthrofibrosis may arise without an obvious cause or it may follow a known cause.

Capsule of the glenohumeral joint

The capsule of the glenohumeral (shoulder) joint is the articular capsule of the shoulder. It completely surrounds the joint. It is attached above to the circumference of the glenoid cavity beyond the glenoidal labrum, and below to the anatomical neck of the humerus, approaching nearer to the articular cartilage above than in the rest of its extent.

Shoulder impingement syndrome syndrome which occurs when the tendons of the rotator cuff muscles become irritated and inflamed as they pass through the subacromial space, the passage beneath the acromion

Shoulder impingement syndrome is a syndrome involving tendonitis of the rotator cuff muscles as they pass through the subacromial space, the passage beneath the acromion. It is particularly associated with tendonitis of the supraspinatus muscle. This can result in pain, weakness, and loss of movement at the shoulder.

References

  1. 1 2 3 4 5 Kelley MJ, Shaffer MA, Kuhn JE, Michener LA, Seitz AL, Uhl TL, et al. (May 2013). "Shoulder pain and mobility deficits: adhesive capsulitis". The Journal of Orthopaedic and Sports Physical Therapy. 43 (5): A1-31. doi:10.2519/jospt.2013.0302. PMID   23636125.
  2. ↑ "Your Orthopaedic Connection: Frozen Shoulder" . Retrieved 2008-01-28.
  3. ↑ Burnham J. "Frozen Shoulder Diagnosis & Management" . Retrieved 25 January 2017.
  4. ↑ "Reduce Frozen Shoulder Recovery Time". 2016-06-24. Retrieved 2016-07-12.
  5. ↑ Jayson MI (October 1981). "Frozen shoulder: adhesive capsulitis". British Medical Journal. 283 (6298): 1005–6. doi:10.1136/bmj.283.6298.1005. JSTOR   29503905. PMC   1495653 . PMID   6794738.
  6. 1 2 3 4 5 Le, Hai V.; Lee, Stella J.; Nazarian, Ara; Rodriguez, Edward K. (2017). "Adhesive capsulitis of the shoulder: review of pathophysiology and current clinical treatments". Shoulder & Elbow. 9 (2): 75–84. doi:10.1177/1758573216676786. ISSN   1758-5732. PMC   5384535 . PMID   28405218.
  7. ↑ Shaikh A, Sundaram M (January 2009). "Adhesive capsulitis demonstrated on magnetic resonance imaging". Orthopedics. 32 (1): 2–62. doi:10.3928/01477447-20090101-20. PMID   19226048.
  8. ↑ Arend CF. Ultrasound of the Shoulder. Master Medical Books, 2013. Chapter on ultrasound findings of adhesive capsulitis available at ShoulderUS.com
  9. 1 2 3 Ewald A (February 2011). "Adhesive capsulitis: a review". American Family Physician. 83 (4): 417–22. PMID   21322517.
  10. ↑ Buchbinder R, Green S, Youd JM, Johnston RV (October 2006). "Oral steroids for adhesive capsulitis". The Cochrane Database of Systematic Reviews (4): CD006189. doi:10.1002/14651858.cd006189. PMID   17054278.
  11. ↑ Sun Y, Lu S, Zhang P, Wang Z, Chen J (May 2016). "Steroid Injection Versus Physiotherapy for Patients With Adhesive Capsulitis of the Shoulder: A PRIMSA Systematic Review and Meta-Analysis of Randomized Controlled Trials". Medicine. 95 (20): e3469. doi:10.1097/MD.0000000000003469. PMC   4902394 . PMID   27196452.
  12. ↑ Buchbinder R, Green S, Youd JM (2003-01-20). "Corticosteroid injections for shoulder pain". The Cochrane Database of Systematic Reviews (1): CD004016. doi:10.1002/14651858.cd004016. PMC   6464922 . PMID   12535501.
  13. ↑ Kitridis, D; Tsikopoulos, K; Bisbinas, I; Papaioannidou, P; Givissis, P (December 2019). "Efficacy of Pharmacological Therapies for Adhesive Capsulitis of the Shoulder: A Systematic Review and Network Meta-analysis". The American Journal of Sports Medicine. 47 (14): 3552–3560. doi:10.1177/0363546518823337. PMID   30735431.
  14. ↑ Bloom JE, Rischin A, Johnston RV, Buchbinder R (August 2012). "Image-guided versus blind glucocorticoid injection for shoulder pain". The Cochrane Database of Systematic Reviews (8): CD009147. doi:10.1002/14651858.cd009147.pub2. PMID   22895984.
  15. ↑ Minns Lowe, C; Barrett, E; McCreesh, K; de Búrca, N; Lewis, J (2019). "Clinical effectiveness of non-surgical interventions for primary frozen shoulder: A systematic review". Journal of Rehabilitation Medicine: 0. doi:10.2340/16501977-2578. ISSN   1650-1977.
  16. 1 2 Noten, Suzie; Meeus, Mira; Stassijns, Gaetane; Glabbeek, Francis Van; Verborgt, Olivier; Struyf, Filip (2016-05-01). "Efficacy of Different Types of Mobilization Techniques in Patients With Primary Adhesive Capsulitis of the Shoulder: A Systematic Review". Archives of Physical Medicine and Rehabilitation. 97 (5): 815–825. doi:10.1016/j.apmr.2015.07.025. ISSN   0003-9993. PMID   26284892.
  17. ↑ Green S, Buchbinder R, Hetrick S (2003-04-22). "Physiotherapy interventions for shoulder pain". The Cochrane Database of Systematic Reviews (2): CD004258. doi:10.1002/14651858.cd004258. PMID   12804509.
  18. ↑ Tveitå EK, Tariq R, Sesseng S, Juel NG, Bautz-Holter E (April 2008). "Hydrodilatation, corticosteroids and adhesive capsulitis: a randomized controlled trial". BMC Musculoskeletal Disorders. 9: 53. doi:10.1186/1471-2474-9-53. PMC   2374785 . PMID   18423042.
  19. ↑ Buchbinder R, Green S, Youd JM, Johnston RV, Cumpston M (January 2008). "Arthrographic distension for adhesive capsulitis (frozen shoulder)". The Cochrane Database of Systematic Reviews (1): CD007005. doi:10.1002/14651858.cd007005. PMID   18254123.
  20. ↑ Baums MH, Spahn G, Nozaki M, Steckel H, Schultz W, Klinger HM (May 2007). "Functional outcome and general health status in patients after arthroscopic release in adhesive capsulitis". Knee Surgery, Sports Traumatology, Arthroscopy. 15 (5): 638–44. doi:10.1007/s00167-006-0203-x. PMID   17031613.
  21. ↑ D'Orsi GM, Via AG, Frizziero A, Oliva F (April 2012). "Treatment of adhesive capsulitis: a review". Muscles, Ligaments and Tendons Journal. 2 (2): 70–8. PMC   3666515 . PMID   23738277.
  22. ↑ Cho CH, Bae KC, Kim DH (September 2019). "Treatment Strategy for Frozen Shoulder". Clinics in Orthopedic Surgery. 11 (3): 249–257. doi:10.4055/cios.2019.11.3.249. PMC   6695331 . PMID   31475043.
  23. ↑ Bunker T (2009). "Time for a new name for frozen shoulder—contracture of the shoulder". Shoulder&Elbow. 1: 4–9. doi:10.1111/j.1758-5740.2009.00007.x.
  24. ↑ Minns Lowe, C; Barrett, E; McCreesh, K; de Búrca, N; Lewis, J (2019). "Clinical effectiveness of non-surgical interventions for primary frozen shoulder: A systematic review". Journal of Rehabilitation Medicine: 0. doi:10.2340/16501977-2578. ISSN   1650-1977.
  25. ↑ Yang, Ajax; Sokolof, Jonas; Gulati, Amitabh (September 2018). "The effect of preoperative exercise on upper extremity recovery following breast cancer surgery: a systematic review". International Journal of Rehabilitation Research. Internationale Zeitschrift Fur Rehabilitationsforschung. Revue Internationale De Recherches De Readaptation. 41 (3): 189–196. doi:10.1097/MRR.0000000000000288. ISSN   1473-5660. PMID   29683834.
  26. ↑ "Questions and Answers about Shoulder Problems" . Retrieved 2008-01-28.

This article contains text from the public domain document "Frozen Shoulder", American Academy of Orthopaedic Surgeons.

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