Adhesive capsulitis: a review of frozen shoulder.

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Adhesive capsulitis is typically idiopathic but may be associated with autoimmune conditions such as DM and thyroid conditions. It may also be secondary to surgery, fracture, or immobilization.

The prevalence in the general population is 2-5%, median age is 55 y.o., and it typically involves the non-dominant arm. Occurrence has been reported to be as high as 20% in diabetic patients.

The pathogenesis is currently unknown but is suspected to be due to inflammation of the joint. Inflammation leads to pain followed by fibrosis of the synovial lining leading to decreased ROM.

There are three phases of this condition. Phase 1 (painful phase): inflammation and pain leading to joint stiffness. Phase 2 (adhesive phase): leading to decreased ROM. Phase 3 (thawing phase): leading to a gradual recovery of ROM, this phase can take up to 2 years.

ER is typically the first motion lost in adhesive capsulitis. Diagnosis is made clinically, and imaging is not required. Patients will present with pain and decreased ROM. Hawkins and Speeds test may be positive.

In most cases, adhesive capsulitis is a self-limited disease with high rates of spontaneous recovery within 18 to 30 months. Treatment is focused on symptomatic relief and improving ROM (1)

Non-surgical treatments include: NSAIDs, physical therapy, manipulation, and steroid injection. In refractory cases, surgical capsular release may be required. Long-term disability has been reported in 10% to 20% of patients and persistence of symptoms in 30% to 60%. (1)

Patients with adhesive capsulitis will present with ↓ROM and pain. The diagnosis can be made clinically, and imaging/labs are not usually required. Most patients will spontaneously recover, and treatment involves inflammation/pain control and physical therapy.

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Ortho Reviews - Adhesive Capsulitis