Adhesive Capsulitis (Frozen Shoulder)
A self-limiting but prolonged inflammatory and fibrotic contracture of the glenohumeral capsule producing marked pain and loss of motion.
Overview
Adhesive capsulitis is characterised by inflammation and subsequent fibrotic contracture of the glenohumeral joint capsule, most notably the rotator interval and coracohumeral ligament. Primary (idiopathic) and secondary (post-traumatic, post-surgical, associated with diabetes or thyroid disease) forms are recognised. The hallmark is global loss of both active and passive range of motion.
Epidemiology
Lifetime prevalence is 2 to 5 percent in the general population and up to 20 percent in patients with diabetes. It most commonly affects women aged 40 to 60 and has a predilection for the non-dominant shoulder. Bilateral involvement, sequentially rather than simultaneously, is seen in up to 20 percent.
Symptoms
The classic three-phase course comprises painful (freezing), stiff (frozen), and thawing phases, each lasting several months. Patients describe progressive loss of external rotation, difficulty reaching behind the back, and severe night pain. Passive motion is equally restricted as active motion, distinguishing it from rotator cuff disease.