Clinical Presentation of Adhesive Capsulitis
Adhesive capsulitis presents with progressive, painful restriction of both active and passive shoulder range of motion, with external rotation being the most severely and characteristically affected movement, followed by abduction and internal rotation. 1, 2, 3
Cardinal Clinical Features
Pain and Motion Restriction Pattern
- External (lateral) rotation is the most significantly affected motion and correlates strongly with the onset of shoulder pain 1
- Abduction becomes severely restricted, particularly in the frozen stage 1
- Internal rotation is typically the last motion to be affected and most difficult to recover 4
- Both active and passive range of motion are equally limited, distinguishing this from rotator cuff pathology 2
- Pain is typically gradual in onset and progressive 2, 3
Anatomical Structures Involved
- The rotator interval and axillary recess show capsular thickening and contracture 1
- Coracohumeral ligament thickening is highly specific for adhesive capsulitis on imaging 3
- The glenohumeral joint capsule undergoes fibrosis and contracture 2, 5
Disease Stages and Progression
Three-Phase Clinical Course
- Freezing phase: Characterized by progressive pain and early motion loss 4, 3
- Frozen phase: Predominant stiffness with plateau of motion restriction 4, 3
- Thawing phase: Gradual recovery of motion 4, 3
Important caveat: While traditionally thought to be self-limiting over 1-2 years with full resolution, recent evidence demonstrates persistent functional limitations if left untreated, challenging the assumption of complete spontaneous recovery 3
Associated Conditions and Risk Factors
High-Risk Populations
- Diabetes mellitus patients have increased prevalence 3
- Hypothyroidism is associated with higher incidence 3
- Post-stroke patients show up to 67% incidence when combined motor, sensory, and visuoperceptual deficits are present 1
- Breast cancer patients require monitoring for early signs 6
Post-Stroke Specific Presentations
- Shoulder tissue injury (effusion, tendinopathy, rotator cuff tears) occurs in approximately one-third of acute stroke patients and may contribute to capsulitis development 1
- Spasticity correlates with shoulder complications, though definitive causation remains unconfirmed 1
- When shoulder-hand syndrome develops, metacarpophalangeal and proximal interphalangeal joints show pain, tenderness, and edema 1
Diagnostic Findings
Imaging Characteristics
- Bone scintigraphy demonstrates increased periarticular activity in the affected shoulder 7, 6, 1
- Triple phase bone scan shows increased periarticular uptake in distal upper extremity joints when shoulder-hand syndrome is present 1
- Coracohumeral ligament thickening on non-contrast MRI yields high specificity 3
Note: Imaging is not necessary to make the diagnosis, which remains primarily clinical 3
Impact on Quality of Life and Function
Functional Consequences
- Adhesive capsulitis can delay rehabilitation and functional recovery, particularly in stroke patients 7, 6, 1
- The condition may mask motor function improvement or inhibit use of assistive devices like canes or wheelchairs 1
- Delayed rehabilitation due to pain limits participation in therapy 1
Psychosocial Impact
- Depression and sleeplessness commonly occur and contribute to reduced quality of life 7, 1
- The condition significantly impacts overall quality of life 6
Differential Diagnosis Considerations
Critical distinction: Other shoulder pathology can produce a similar clinical picture and must be excluded 2. Subtle clues in history and physical examination help differentiate true adhesive capsulitis from:
- Rotator cuff pathology (active motion more limited than passive in rotator cuff disease) 2
- Degenerative joint disease or osteoarthritis 8
- Soft tissue rheumatic disorders (rotator cuff tendinitis) 8
- Crystal arthropathies 8
- Septic arthritis 8
The key distinguishing feature is equal restriction of both active and passive motion in all planes, particularly external rotation, in adhesive capsulitis. 1, 2, 3