MANUAL MINORS
Adhesive capsulitis, also known as frozen shoulder, is a condition characterised by thickening and contraction of the shoulder joint capsule, leading to progressively restricted movement in the joint.
This condition primarily affects people aged 40 to 60, with a higher prevalence in women and individuals with metabolic diseases such as diabetes. Adhesive capsulitis progresses through three phases: initial pain, progressive stiffness, and recovery.
Diagnosis
Diagnosis is based on a clinical history of gradually worsening shoulder pain and stiffness. In the initial phase, pain is the predominant symptom, while in the advanced stages, severe limitation of range of motion becomes more evident, affecting both active and passive movements.
Physical examination reveals a global restriction of motion, particularly in abduction and external rotation. X-rays are typically normal, but magnetic resonance imaging (MRI) may show thickening of the joint capsule and help rule out other causes.
Differential Diagnosis
Pathology | Characteristics |
|---|---|
Rotator cuff tendinitis | Pain during movement without severe stiffness limiting passive movements |
Shoulder arthritis | Chronic pain and progressive stiffness with degenerative changes visible on X-rays |
Impingement syndrome | Pain with overhead movements, without severe mobility restriction |
Rotator cuff tear | Significant weakness without complete stiffness |
Emergency Management
Emergency management of adhesive capsulitis includes the use of analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) to relieve pain. Intra-articular corticosteroid injections can be helpful to reduce inflammation and temporarily improve range of motion. It is important to avoid prolonged shoulder immobilisation, as this can worsen stiffness.
Definitive Treatment
Definitive treatment is conservative in most cases, focusing on physiotherapy to restore range of motion and improve shoulder function. The goal is to gradually mobilise the joint without causing increased pain. Stretching and strengthening exercises are essential during the recovery phase.
In severe or refractory cases, manipulation under anaesthesia or capsular release via arthroscopy may be considered, allowing for the release of adhesions in the capsule and restoration of movement. Full recovery can take several months, and rehabilitation is crucial to avoid complications and restore shoulder functionality.
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