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Frozen Shoulder / Adhesive Capsulitis
Definition: Frozen shoulder is a condition characterised by a reduction in the potential space provided by the inferior aspect of the glenohumeral joint capsule as a result of soft-tissue adhesions.
Causes: The exact causes of frozen shoulder are unknown however, there are certain conditions which are associated with adhesive capsulitis. Recent surgery, rheumatic disease, trauma, fractures, cardiovascular and pulmonary disease, and diabetes have all been implicated in frozen shoulder. Adhesive capsulitis has also been indicated as a possible adverse reaction of certain anti-retroviral medications.
Frozen shoulder is most manifest in patients over the age of fourty, and tends to affect the non-dominant arm more frequently. About one two thirds of patients suffering from adhesive capsulitis are female gender.
Examination: The presentation of frozen shoulder is sub-divided into three phases:
1. Freezing or painful stage: there is a progressive onset of pain over the affected shoulder, with associated diminution in its range of motion. This stage may last between six to nine months.
2. Frozen or adhesive stage: there is a reduction in pain however, the stiffness remains. This stage may last between four to nine months.
3. Thawing or recovery: in this stage there is amelioration in both pain and especially range of motion.
It is worth noting that the range of motion in shoulders affected by adhesive capsulitis is diminished both actively and passively
Observation of patients suffering from frozen shoulder:
Signs and symptoms will help determine which stage the adhesive capsulitis is in. A marked reduction in internal rotation is often pathoneumonic. Definitive diagnosis requires the injection if radio-opaque fluid into the shoulder capsule in an attempt to ascertain whether there is a significant reduction in the potential space provided by the joint capsule.