What is Adhesive Capsulitis
Adhesive capsulitis, commonly known as "frozen shoulder," is a painful shoulder condition characterized by progressive loss of both active and passive range of motion, particularly in external rotation, caused by inflammation and subsequent fibrosis of the glenohumeral joint capsule. 1
Clinical Definition and Pathophysiology
Adhesive capsulitis is a musculoskeletal disorder affecting the shoulder joint that involves inflammation and stiffness of the joint capsule, which greatly restricts motion and strength 2. The condition specifically involves:
- Capsular thickening and contracture, most commonly affecting the rotator interval and axillary recess 3
- Coracohumeral ligament thickening, which can be detected on imaging and is highly specific for the diagnosis 1
- Progressive fibrosis of the glenohumeral joint capsule leading to restricted movement 1
Disease Progression
The condition typically progresses through three distinct clinical phases 4, 1, 5:
- Freezing phase (painful phase): Characterized by progressive pain and gradual loss of range of motion
- Frozen phase: Marked by persistent stiffness with plateau of motion restriction; abduction becomes severely restricted during this stage 3
- Thawing phase (recovery phase): Gradual improvement in range of motion
External (lateral) rotation is the most significantly affected motion and relates strongly to the onset of shoulder pain 3. Abduction is severely restricted particularly in the frozen stage 3.
Epidemiology and Risk Factors
- The condition predominantly affects middle-aged women 5
- Increased prevalence occurs in patients with diabetes mellitus and hypothyroidism 1
- Can occur as a primary idiopathic condition or secondary to other shoulder pathologies (rotator cuff tendinopathy, bursitis) 6
- In post-stroke patients, up to 67% incidence of shoulder-hand-pain syndrome is observed in those with combined motor, sensory, and visuoperceptual deficits 3
Clinical Impact and Complications
Adhesive capsulitis significantly impacts quality of life and can contribute to depression, sleep disturbances, and reduced functional capacity 7. Specific complications include:
- Delayed rehabilitation and functional recovery, particularly in stroke patients, potentially masking motor function improvement or inhibiting use of assistive devices 8, 3
- Depression and sleeplessness contributing to reduced quality of life 3
- In post-stroke patients, delayed rehabilitation due to pain can limit participation in therapy and use of canes or wheelchairs for ambulation 3
Natural History
Traditionally, adhesive capsulitis was thought to be self-limiting, lasting one to two years with full resolution without treatment 6. However, recent evidence demonstrates persistent functional limitations if left untreated, challenging the assumption of complete spontaneous recovery 1. The disease usually persists for 2-3 years, though patients may suffer from pain and limited range of motion beyond this timeframe 5.
Diagnostic Considerations
The diagnosis is primarily clinical 6, 1, though imaging helps exclude differential diagnoses:
- Bone scintigraphy demonstrates increased periarticular activity in the affected shoulder 8, 7, 3
- Radiography allows exclusion of common differential diagnoses such as osteoarthritis or calcific tendinitis 5
- MRI reveals pathomorphologies typical of adhesive capsulitis, with coracohumeral ligament thickening yielding high specificity 1, 5
Common Pitfalls
- Improper handling during rehabilitation, such as overhead pulley exercises in post-stroke patients, can increase the risk of hemiplegic shoulder pain 3
- The condition can occur concomitantly with other shoulder pathologies, requiring careful evaluation to identify all contributing factors 6
- In breast cancer patients, early identification and treatment may prevent unnecessary pauses during exercise programming 7