Adhesive capsulitis of shoulder: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Adhesive Capsulitis of Shoulder}} | {{Adhesive Capsulitis of Shoulder}} | ||
{{CMG}}; {{AE}} {{MMT}} | {{CMG}}; {{AE}} {{MMT}} | ||
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'''For patient information, click [[Adhesive capsulitis of shoulder (Patient information)|here]]''' | '''For patient information, click [[Adhesive capsulitis of shoulder (Patient information)|here]]''' | ||
{{SK}} Frozen shoulder syndrome; Adhesive capsulitis; Duplay Bursitis, Scapulohumeral periarthritis; Arthofibrosis; Shoulder pain; Shoulder stiffness; Shoulder Capsulitis. | {{SK}} [[Frozen shoulder (patient information)|Frozen shoulder syndrome]]; [[Adhesive capsulitis of shoulder (Patient information)|Adhesive capsulitis]]; Duplay [[Bursitis]], Scapulohumeral periarthritis; Arthofibrosis; [[Shoulder pain]]; [[Shoulder problems|Shoulder stiffness]]; Shoulder Capsulitis. | ||
==Overview== | ==Overview== | ||
Adhesive capsulitis is an inflammatory insult to glenohumeral joint limiting range of motion actively and passively due to pain and stiffness of shoulder | [[Adhesive capsulitis of shoulder (Patient information)|Adhesive capsulitis]] is an [[inflammatory]] insult to [[Glenohumeral joint|glenohumeral]] joint limiting [[range of motion]] actively and passively due to [[pain]] and [[stiffness]] of [[Shoulder joint|shoulder join]]<nowiki/>t. The [[range of motion]] is debilitated due to [[inflammation]] and [[fibrosis]] of adhesive [[Bursa (anatomy)|bursa]] due to primary and secondary causes. | ||
==Historical Perspective== | ==Historical Perspective== | ||
*Adhesive capsulitis was first discovered by Simon Emmanuel Duplay, a French surgeon, in 1872 who introduced the term 'scapulohumeral periarthritis' to identify painful shoulder with normal preservation of imaging findings. In 1934 Earnest Codman termed it as Frozen Shoulder' as there was loss of range of motion at shoulder joint. Later in 1945, due to the involvement of inflammation of capsule leading to fibrosis of bursa was elaborated by Julius Neviaser, he named it 'Adhesive capsulitis'.<ref name="pmid28405218">{{cite journal |vauthors=Le HV, Lee SJ, Nazarian A, Rodriguez EK |title=Adhesive capsulitis of the shoulder: review of pathophysiology and current clinical treatments |journal=Shoulder Elbow |volume=9 |issue=2 |pages=75–84 |date=April 2017 |pmid=28405218 |pmc=5384535 |doi=10.1177/1758573216676786 |url=}}</ref><ref name="pmid16356983">{{cite journal |vauthors=Dias R, Cutts S, Massoud S |title=Frozen shoulder |journal=BMJ |volume=331 |issue=7530 |pages=1453–6 |date=December 2005 |pmid=16356983 |pmc=1315655 |doi=10.1136/bmj.331.7530.1453 |url=}}</ref> | |||
*[[Adhesive capsulitis of shoulder (Patient information)|Adhesive capsulitis]] was first discovered by Simon Emmanuel Duplay, a French surgeon, in 1872 who introduced the term 'scapulohumeral periarthritis' to identify [[Shoulder Pain|painful shoulder]] with normal preservation of [[imaging]] findings. In 1934 Earnest Codman termed it as [[Frozen shoulder (patient information)|Frozen Shoulder]]' as there was loss of [[range of motion]] at [[shoulder joint]]. Later in 1945, due to the involvement of [[inflammation]] of [[capsule]] leading to [[fibrosis]] of [[Bursa (anatomy)|bursa]] was elaborated by Julius Neviaser, he named it '[[Adhesive capsulitis of shoulder (Patient information)|Adhesive capsulitis]]'.<ref name="pmid28405218">{{cite journal |vauthors=Le HV, Lee SJ, Nazarian A, Rodriguez EK |title=Adhesive capsulitis of the shoulder: review of pathophysiology and current clinical treatments |journal=Shoulder Elbow |volume=9 |issue=2 |pages=75–84 |date=April 2017 |pmid=28405218 |pmc=5384535 |doi=10.1177/1758573216676786 |url=}}</ref><ref name="pmid16356983">{{cite journal |vauthors=Dias R, Cutts S, Massoud S |title=Frozen shoulder |journal=BMJ |volume=331 |issue=7530 |pages=1453–6 |date=December 2005 |pmid=16356983 |pmc=1315655 |doi=10.1136/bmj.331.7530.1453 |url=}}</ref> | |||
==Classification== | ==Classification== | ||
*Adhesive | |||
*Primary or Idiopathic: | *[[Adhesive capsulitis of shoulder (Patient information)|Adhesive capsulitis]] may be classified according to [[etiology]] into two groups: | ||
**Adhesive capsulitis can occur spontaneously without concurrent shoulder joint abnormality or inciting factors | *Primary or [[Idiopathic]]: | ||
**[[Adhesive capsulitis of shoulder (Patient information)|Adhesive capsulitis]] can occur spontaneously without concurrent [[shoulder joint]] abnormality or inciting factors. | |||
*Secondary: | *Secondary: | ||
**Adhesive capsulitis can present due to preexistent shoulder joint dysfunction for instances glenohumeral joint dislocation with fracture of periarticular region, joint trauma, arthroscopic surgery to shoulder joint, arthroplasty or rotator cuff injury repair.Diabetes mellitus is the most common secondary cause, other than this dysfunctional thyroid gland, adrenal insufficiency, fibromatosis resulting in dupuytren's contracture, cerebrovascular attack, respiratory disease, cardiovascular disease, parkinson's disease, surgery to neck/brain/heart may predispose adhesive capsulitis. <ref name="pmid18171964">{{cite journal |vauthors=Bailie DS, Llinas PJ, Ellenbecker TS |title=Cementless humeral resurfacing arthroplasty in active patients less than fifty-five years of age |journal=J Bone Joint Surg Am |volume=90 |issue=1 |pages=110–7 |date=January 2008 |pmid=18171964 |doi=10.2106/JBJS.F.01552 |url=}}</ref><ref name="pmid26772943">{{cite journal |vauthors=McAlister I, Sems SA |title=Arthrofibrosis After Periarticular Fracture Fixation |journal=Orthop Clin North Am |volume=47 |issue=2 |pages=345–55 |date=April 2016 |pmid=26772943 |doi=10.1016/j.ocl.2015.09.003 |url=}}</ref><ref name="pmid16356983">{{cite journal |vauthors=Dias R, Cutts S, Massoud S |title=Frozen shoulder |journal=BMJ |volume=331 |issue=7530 |pages=1453–6 |date=December 2005 |pmid=16356983 |pmc=1315655 |doi=10.1136/bmj.331.7530.1453 |url=}}</ref><ref name="pmid11057467">{{cite journal |vauthors=Griggs SM, Ahn A, Green A |title=Idiopathic adhesive capsulitis. A prospective functional outcome study of nonoperative treatment |journal=J Bone Joint Surg Am |volume=82 |issue=10 |pages=1398–407 |date=October 2000 |pmid=11057467 |doi= |url=}}</ref><ref name="pmid7559688">{{cite journal |vauthors=Bunker TD, Anthony PP |title=The pathology of frozen shoulder. A Dupuytren-like disease |journal=J Bone Joint Surg Br |volume=77 |issue=5 |pages=677–83 |date=September 1995 |pmid=7559688 |doi= |url=}}</ref> | **[[Adhesive capsulitis of shoulder (Patient information)|Adhesive capsulitis]] can present due to preexistent [[Shoulder problems|shoulder joint dysfunction]] for instances [[glenohumeral joint]] [[Joint dislocation|dislocation]] with [[fracture]] of periarticular region, joint trauma, [[arthroscopic surgery]] to [[shoulder joint]], [[arthroplasty]] or [[Rotator cuff tear|rotator cuff]] injury repair. [[Diabetes mellitus]] is the most common [[secondary]] cause, other than this dysfunctional [[thyroid gland]], [[adrenal insufficiency]], [[fibromatosis]] resulting in [[dupuytren's contracture]], [[Transient Ischemic Attack (TIA)|cerebrovascular attack]], [[respiratory disease]], [[cardiovascular disease]], [[parkinson's disease]], [[Surgery operation|surgery]] to [[Neck|neck/]][[brain]]/[[heart]] may predispose [[Adhesive capsulitis of shoulder (Patient information)|adhesive capsulitis]]. <ref name="pmid18171964">{{cite journal |vauthors=Bailie DS, Llinas PJ, Ellenbecker TS |title=Cementless humeral resurfacing arthroplasty in active patients less than fifty-five years of age |journal=J Bone Joint Surg Am |volume=90 |issue=1 |pages=110–7 |date=January 2008 |pmid=18171964 |doi=10.2106/JBJS.F.01552 |url=}}</ref><ref name="pmid26772943">{{cite journal |vauthors=McAlister I, Sems SA |title=Arthrofibrosis After Periarticular Fracture Fixation |journal=Orthop Clin North Am |volume=47 |issue=2 |pages=345–55 |date=April 2016 |pmid=26772943 |doi=10.1016/j.ocl.2015.09.003 |url=}}</ref><ref name="pmid16356983">{{cite journal |vauthors=Dias R, Cutts S, Massoud S |title=Frozen shoulder |journal=BMJ |volume=331 |issue=7530 |pages=1453–6 |date=December 2005 |pmid=16356983 |pmc=1315655 |doi=10.1136/bmj.331.7530.1453 |url=}}</ref><ref name="pmid11057467">{{cite journal |vauthors=Griggs SM, Ahn A, Green A |title=Idiopathic adhesive capsulitis. A prospective functional outcome study of nonoperative treatment |journal=J Bone Joint Surg Am |volume=82 |issue=10 |pages=1398–407 |date=October 2000 |pmid=11057467 |doi= |url=}}</ref><ref name="pmid7559688">{{cite journal |vauthors=Bunker TD, Anthony PP |title=The pathology of frozen shoulder. A Dupuytren-like disease |journal=J Bone Joint Surg Br |volume=77 |issue=5 |pages=677–83 |date=September 1995 |pmid=7559688 |doi= |url=}}</ref> | ||
==Pathophysiology== | ==Pathophysiology== | ||
*On gross pathology, | *The [[pathogenesis]] of [[Adhesive capsulitis of shoulder (Patient information)|adhesive capsulitis]] is characterized by [[inflammation]] and [[fibrosis]] which is elaborated several pathways mentioned below. | ||
*On microscopic histopathological analysis, cellular infiltration with accumulation of macrophages, T and B cells, mast cells | **In the beginning it was thought [[myofibroblasts]] are playing role in [[Fibrosis|fibrotic]] pathway. low levels of [[Metalloproteinases (MMPs)|metalloproteinases]] (MMP 1,2, 14) and elevated expression are shown by tissue inhibitor of [[metalloproteinases]] ([[TIMP1|TIMP]] 1 or 2) for instances resulting in [[Extracellular matrix|ECM]] imbalances and [[fibrosis]].<ref name="pmid23604641">{{cite journal |vauthors=Lubis AM, Lubis VK |title=Matrix metalloproteinase, tissue inhibitor of metalloproteinase and transforming growth factor-beta 1 in frozen shoulder, and their changes as response to intensive stretching and supervised neglect exercise |journal=J Orthop Sci |volume=18 |issue=4 |pages=519–27 |date=July 2013 |pmid=23604641 |doi=10.1007/s00776-013-0387-0 |url=}}</ref> | ||
**[[Inflammatory]] process involving [[IL-1]]<nowiki/>s (Both alpha/beta), [[Tumor necrosis factor-alpha|TNF- alpha]], [[Cyclooxygenase|Cyclooxygenases]]([[COX-1]] or [[COX-2]]) leading to accumulation of [[macrophage]]<nowiki/>s, [[T cell|T]] and [[B cell]]<nowiki/>s, [[mast cells]] are recently thought to have role [[Adhesive capsulitis of shoulder (Patient information)|adhesive capsulitis]]. <ref name="pmid17673588">{{cite journal |vauthors=Hand GC, Athanasou NA, Matthews T, Carr AJ |title=The pathology of frozen shoulder |journal=J Bone Joint Surg Br |volume=89 |issue=7 |pages=928–32 |date=July 2007 |pmid=17673588 |doi=10.1302/0301-620X.89B7.19097 |url=}}</ref> | |||
**[[Molecules]] like [[ICAM-1]], [[Single nucleotide polymorphism|SNP]]([[Single-nucleotide polymorphism|single- peptide polymorphism]] of [[Interleukin-6]]), [[Metalloproteinases|metalloproteinases-3]], [[IGF-2]], [[Beta-catenin|Beta catenin]] are involved in [[genetic]] association with [[Adhesive capsulitis of shoulder (Patient information)|adhesive capsulitis]].<ref name="pmid28405218">{{cite journal |vauthors=Le HV, Lee SJ, Nazarian A, Rodriguez EK |title=Adhesive capsulitis of the shoulder: review of pathophysiology and current clinical treatments |journal=Shoulder Elbow |volume=9 |issue=2 |pages=75–84 |date=April 2017 |pmid=28405218 |pmc=5384535 |doi=10.1177/1758573216676786 |url=}}</ref> <ref name="pmid23426775">{{cite journal |vauthors=Kim YS, Kim JM, Lee YG, Hong OK, Kwon HS, Ji JH |title=Intercellular adhesion molecule-1 (ICAM-1, CD54) is increased in adhesive capsulitis |journal=J Bone Joint Surg Am |volume=95 |issue=4 |pages=e181–8 |date=February 2013 |pmid=23426775 |doi=10.2106/JBJS.K.00525 |url=}}</ref> <ref name="pmid25090267">{{cite journal |vauthors=Raykha CN, Crawford JD, Burry AF, Drosdowech DS, Faber KJ, Gan BS, O'Gorman DB |title=IGF2 expression and β-catenin levels are increased in Frozen Shoulder Syndrome |journal=Clin Invest Med |volume=37 |issue=4 |pages=E262–7 |date=August 2014 |pmid=25090267 |doi=10.25011/cim.v37i4.21733 |url=}}</ref> | |||
**In recent studies the intolerable pain of [[Adhesive capsulitis of shoulder (Patient information)|adhesive capsulitis]] is explained by the involvement of [[nerve]] invasion by [[nerve growth factor]] receptor p75. [[Vascular endothelial growth factor|VEGF]], PGP9.5([[Protein gene product]] 9.5), [[Mitogen-activated protein kinase|MAPK]]([[Mitogen-activated protein kinase|mitogen-activated protein kinases]])/ENK pathway and [[Mitogen-activated protein kinase|MAPK]]/[[JNK]], Beta-1 [[integrin]]([[CD19]]), [[CD34]], [[NF-kB]], TGF- beta, GAP43([[growth associated protein]] 43) are elevated in pathogenesis in [[Adhesive capsulitis of shoulder (Patient information)|Adhesive capsulitis]].<ref name="pmid19214689">{{cite journal |vauthors=Kanbe K, Inoue K, Inoue Y, Chen Q |title=Inducement of mitogen-activated protein kinases in frozen shoulders |journal=J Orthop Sci |volume=14 |issue=1 |pages=56–61 |date=January 2009 |pmid=19214689 |pmc=2893737 |doi=10.1007/s00776-008-1295-6 |url=}}</ref><ref name="pmid22005128">{{cite journal |vauthors=Xu Y, Bonar F, Murrell GA |title=Enhanced expression of neuronal proteins in idiopathic frozen shoulder |journal=J Shoulder Elbow Surg |volume=21 |issue=10 |pages=1391–7 |date=October 2012 |pmid=22005128 |doi=10.1016/j.jse.2011.08.046 |url=}}</ref> <ref name="pmid20697373">{{cite journal |vauthors=Watson RS, Gouze E, Levings PP, Bush ML, Kay JD, Jorgensen MS, Dacanay EA, Reith JW, Wright TW, Ghivizzani SC |title=Gene delivery of TGF-β1 induces arthrofibrosis and chondrometaplasia of synovium in vivo |journal=Lab Invest |volume=90 |issue=11 |pages=1615–27 |date=November 2010 |pmid=20697373 |pmc=3724510 |doi=10.1038/labinvest.2010.145 |url=}}</ref><ref name="pmid17673588">{{cite journal |vauthors=Hand GC, Athanasou NA, Matthews T, Carr AJ |title=The pathology of frozen shoulder |journal=J Bone Joint Surg Br |volume=89 |issue=7 |pages=928–32 |date=July 2007 |pmid=17673588 |doi=10.1302/0301-620X.89B7.19097 |url=}}</ref> | |||
*On [[gross pathology]], [[Inflammation|inflammatio]]<nowiki/>n, [[congestion]], [[fibrosis]] of [[capsule]] are characteristic findings of [[Adhesive capsulitis of shoulder (Patient information)|adhesive capsulit]]<nowiki/>is.<ref name="pmid17673588">{{cite journal |vauthors=Hand GC, Athanasou NA, Matthews T, Carr AJ |title=The pathology of frozen shoulder |journal=J Bone Joint Surg Br |volume=89 |issue=7 |pages=928–32 |date=July 2007 |pmid=17673588 |doi=10.1302/0301-620X.89B7.19097 |url=}}</ref> | |||
*On [[microscopic]] [[histopathological]] [[analysis]], [[cellular infiltration]] with accumulation of [[macrophages]], [[T cell|T]] and [[B cells]], mast cells are characteristic findings of [[Adhesive capsulitis of shoulder (Patient information)|adhesive capsulitis]].<ref name="pmid17673588">{{cite journal |vauthors=Hand GC, Athanasou NA, Matthews T, Carr AJ |title=The pathology of frozen shoulder |journal=J Bone Joint Surg Br |volume=89 |issue=7 |pages=928–32 |date=July 2007 |pmid=17673588 |doi=10.1302/0301-620X.89B7.19097 |url=}}</ref> | |||
==Causes== | ==Causes== | ||
Adhesive Capsulitis may be caused by primarily or Secondarily. Diabetes Mellitus is most common cause of adhesive capsulitis among the secondary cause. The etiologies are: | [[Adhesive capsulitis of shoulder (Patient information)|Adhesive Capsulitis]] may be caused by primarily or Secondarily. [[Diabetes mellitus|Diabetes Mellitus]] is most common cause of adhesive capsulitis among the [[Secondary|secondary cause]]. The etiologies are: | ||
**Primary or Idiopathic: | |||
***Adhesive capsulitis can occur spontaneously without concurrent shoulder joint abnormality or inciting factors | **Primary or [[Idiopathic]]: | ||
***[[Adhesive capsulitis of shoulder (Patient information)|Adhesive capsulitis]] can occur spontaneously without concurrent shoulder joint abnormality or inciting factors | |||
**Secondary: | **Secondary: | ||
***Adhesive capsulitis can present due to | ***[[Adhesive capsulitis of shoulder (Patient information)|Adhesive capsulitis]] can present due to preexisten[[Shoulder joint|t shoulder joint]] dysfunction for instances [[glenohumeral joint]] [[Joint dislocation|dislocation]] with fracture of periarticular region, joint trauma, [[Arthroscopic surgery|arthroscopic]] surgery to [[shoulder joint]], [[arthroplasty]] or [[Rotator cuff tear|rotator cuff]] injury repair. <ref name="pmid18171964">{{cite journal |vauthors=Bailie DS, Llinas PJ, Ellenbecker TS |title=Cementless humeral resurfacing arthroplasty in active patients less than fifty-five years of age |journal=J Bone Joint Surg Am |volume=90 |issue=1 |pages=110–7 |date=January 2008 |pmid=18171964 |doi=10.2106/JBJS.F.01552 |url=}}</ref><ref name="pmid26772943">{{cite journal |vauthors=McAlister I, Sems SA |title=Arthrofibrosis After Periarticular Fracture Fixation |journal=Orthop Clin North Am |volume=47 |issue=2 |pages=345–55 |date=April 2016 |pmid=26772943 |doi=10.1016/j.ocl.2015.09.003 |url=}}</ref> [[Systemic illnesses]] are associated in causing secondary [[Adhesive capsulitis of shoulder (Patient information)|adhesive capsulitis]], plays greater role than preexisting [[Arthralgia|joint dysfunction]]. Diabetes mellitus is the most common [[secondary cause]], other than this dysfunctional [[thyroid gland]], [[adrenal insufficiency]], [[fibromatosis]] resulting in [[Dupuytrens contracture|dupuytren's contracture]], [[Transient ischemic attack|cerebrovascular attac]]<nowiki/>k, [[respiratory disease]], [[Cardiovascular disease|cardiovascular disea]]<nowiki/>se, [[Parkinson's disease|parkinson's diseas]]<nowiki/>e, [[surgery]] to [[neck]]/[[brain]]/[[heart]] may predispose [[Adhesive capsulitis of shoulder (Patient information)|adhesive capsuliti]]<nowiki/>s. <ref name="pmid18171964">{{cite journal |vauthors=Bailie DS, Llinas PJ, Ellenbecker TS |title=Cementless humeral resurfacing arthroplasty in active patients less than fifty-five years of age |journal=J Bone Joint Surg Am |volume=90 |issue=1 |pages=110–7 |date=January 2008 |pmid=18171964 |doi=10.2106/JBJS.F.01552 |url=}}</ref><ref name="pmid26772943">{{cite journal |vauthors=McAlister I, Sems SA |title=Arthrofibrosis After Periarticular Fracture Fixation |journal=Orthop Clin North Am |volume=47 |issue=2 |pages=345–55 |date=April 2016 |pmid=26772943 |doi=10.1016/j.ocl.2015.09.003 |url=}}</ref><ref name="pmid16356983">{{cite journal |vauthors=Dias R, Cutts S, Massoud S |title=Frozen shoulder |journal=BMJ |volume=331 |issue=7530 |pages=1453–6 |date=December 2005 |pmid=16356983 |pmc=1315655 |doi=10.1136/bmj.331.7530.1453 |url=}}</ref><ref name="pmid11057467">{{cite journal |vauthors=Griggs SM, Ahn A, Green A |title=Idiopathic adhesive capsulitis. A prospective functional outcome study of nonoperative treatment |journal=J Bone Joint Surg Am |volume=82 |issue=10 |pages=1398–407 |date=October 2000 |pmid=11057467 |doi= |url=}}</ref><ref name="pmid7559688">{{cite journal |vauthors=Bunker TD, Anthony PP |title=The pathology of frozen shoulder. A Dupuytren-like disease |journal=J Bone Joint Surg Br |volume=77 |issue=5 |pages=677–83 |date=September 1995 |pmid=7559688 |doi= |url=}}</ref> | ||
==Differentiating Adhesive capsulitis from other Diseases== | ==Differentiating Adhesive capsulitis from other Diseases== | ||
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==Epidemiology and Demographics== | ==Epidemiology and Demographics== | ||
* The | |||
* The incidence of adhesive capsulitis was estimated to be 3 to 5% with 20% cases related with diabetes | *The [[Prevalence|prevalenc]]<nowiki/>e of [[Adhesive capsulitis of shoulder (Patient information)|adhesive capsulitis]] is approximately 2 to 5.3 % in individuals worldwide.<ref name="urlAdhesive Capsulitis - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK532955/ |title=Adhesive Capsulitis - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref> | ||
*The [[incidence]] of [[Adhesive capsulitis of shoulder (Patient information)|adhesive capsulitis]] was estimated to be 3 to 5% with 20% cases related with [[Diabetes mellitus|diabetes mell]]<nowiki/>itus.<ref name="pmid28405218">{{cite journal |vauthors=Le HV, Lee SJ, Nazarian A, Rodriguez EK |title=Adhesive capsulitis of the shoulder: review of pathophysiology and current clinical treatments |journal=Shoulder Elbow |volume=9 |issue=2 |pages=75–84 |date=April 2017 |pmid=28405218 |pmc=5384535 |doi=10.1177/1758573216676786 |url=}}</ref> | |||
===Age=== | ===Age=== | ||
*Adhesive capsulitis is more commonly observed among patients aged 40 to 59 years with an average age of 55 years old.<ref name="pmid9268913">{{cite journal |vauthors=Boyle-Walker KL, Gabard DL, Bietsch E, Masek-VanArsdale DM, Robinson BL |title=A profile of patients with adhesive capsulitis |journal=J Hand Ther |volume=10 |issue=3 |pages=222–8 |date=1997 |pmid=9268913 |doi=10.1016/s0894-1130(97)80025-7 |url=}}</ref> | |||
*[[Adhesive capsulitis of shoulder (Patient information)|Adhesive capsuliti]]<nowiki/>s is more commonly observed among patients aged 40 to 59 years with an [[average]] age of 55 years old.<ref name="pmid9268913">{{cite journal |vauthors=Boyle-Walker KL, Gabard DL, Bietsch E, Masek-VanArsdale DM, Robinson BL |title=A profile of patients with adhesive capsulitis |journal=J Hand Ther |volume=10 |issue=3 |pages=222–8 |date=1997 |pmid=9268913 |doi=10.1016/s0894-1130(97)80025-7 |url=}}</ref> | |||
===Gender=== | ===Gender=== | ||
*Female are more commonly affected with adhesive | *Female are more commonly affected with [[Adhesive capsulitis of shoulder (Patient information)|adhesive capsuliti]]<nowiki/>s than male comprising of 70% of total cases.<ref name="pmid17141009">{{cite journal |vauthors=Sheridan MA, Hannafin JA |title=Upper extremity: emphasis on frozen shoulder |journal=Orthop Clin North Am |volume=37 |issue=4 |pages=531–9 |date=October 2006 |pmid=17141009 |doi=10.1016/j.ocl.2006.09.009 |url=}}</ref> | ||
===Race=== | ===Race=== | ||
*People from African American and Hispanic or Latino race are more likely to have association with Adhesive capsulitis.<ref name="pmid29807717">{{cite journal |vauthors=Kingston K, Curry EJ, Galvin JW, Li X |title=Shoulder adhesive capsulitis: epidemiology and predictors of surgery |journal=J Shoulder Elbow Surg |volume=27 |issue=8 |pages=1437–1443 |date=August 2018 |pmid=29807717 |doi=10.1016/j.jse.2018.04.004 |url=}}</ref> | |||
*People from African American and Hispanic or Latino race are more likely to have association with [[Adhesive capsulitis of shoulder (Patient information)|Adhesive capsulitis]].<ref name="pmid29807717">{{cite journal |vauthors=Kingston K, Curry EJ, Galvin JW, Li X |title=Shoulder adhesive capsulitis: epidemiology and predictors of surgery |journal=J Shoulder Elbow Surg |volume=27 |issue=8 |pages=1437–1443 |date=August 2018 |pmid=29807717 |doi=10.1016/j.jse.2018.04.004 |url=}}</ref> | |||
==Risk Factors== | ==Risk Factors== | ||
*Common risk factors in the development of adhesive | |||
*Common risk factors in the development of [[Adhesive capsulitis of shoulder (Patient information)|adhesive capsulit]]<nowiki/>is are mentioned below<ref name="pmid18171964">{{cite journal |vauthors=Bailie DS, Llinas PJ, Ellenbecker TS |title=Cementless humeral resurfacing arthroplasty in active patients less than fifty-five years of age |journal=J Bone Joint Surg Am |volume=90 |issue=1 |pages=110–7 |date=January 2008 |pmid=18171964 |doi=10.2106/JBJS.F.01552 |url=}}</ref><ref name="pmid26772943">{{cite journal |vauthors=McAlister I, Sems SA |title=Arthrofibrosis After Periarticular Fracture Fixation |journal=Orthop Clin North Am |volume=47 |issue=2 |pages=345–55 |date=April 2016 |pmid=26772943 |doi=10.1016/j.ocl.2015.09.003 |url=}}</ref><ref name="pmid16356983">{{cite journal |vauthors=Dias R, Cutts S, Massoud S |title=Frozen shoulder |journal=BMJ |volume=331 |issue=7530 |pages=1453–6 |date=December 2005 |pmid=16356983 |pmc=1315655 |doi=10.1136/bmj.331.7530.1453 |url=}}</ref><ref name="pmid11057467">{{cite journal |vauthors=Griggs SM, Ahn A, Green A |title=Idiopathic adhesive capsulitis. A prospective functional outcome study of nonoperative treatment |journal=J Bone Joint Surg Am |volume=82 |issue=10 |pages=1398–407 |date=October 2000 |pmid=11057467 |doi= |url=}}</ref><ref name="pmid7559688">{{cite journal |vauthors=Bunker TD, Anthony PP |title=The pathology of frozen shoulder. A Dupuytren-like disease |journal=J Bone Joint Surg Br |volume=77 |issue=5 |pages=677–83 |date=September 1995 |pmid=7559688 |doi= |url=}}</ref>: | |||
**Gender: female | **Gender: female | ||
**Age: 40-59 years | **Age: 40-59 years | ||
**Diabetes Mellitus | **[[Diabetes mellitus|Diabetes Mellitus]] | ||
**Preexistent shoulder joint dysfunction | **Preexistent [[shoulder joint]] dysfunction | ||
**History of trauma | **History of trauma | ||
**Immobilization | **Immobilization | ||
**HLA-B27 | **[[HLA-B27]] | ||
**Dysfunctional thyroid gland | **Dysfunctional [[thyroid gland]] | ||
**Adrenal insufficiency | **[[Adrenal insufficiency]] | ||
**Fibromatosis resulting in dupuytren's contracture | **[[Fibromatosis]] resulting in [[Dupuytrens contracture|dupuytren's contracture]] | ||
**Cerebrovascular attack, respiratory disease, cardiovascular disease | **[[Cerebrovascular attack]], [[Respiratory disease|respiratory disease,]] [[cardiovascular disease]] | ||
**Parkinson's disease | **[[Parkinson's disease]] | ||
**surgery to neck/brain/heart | **surgery to [[neck]]/[[brain]]/[[heart]] | ||
==Natural History, Complications and Prognosis== | |||
*[[Adhesive capsulitis of shoulder (Patient information)|Adhesive capsulitis]] has clinical features occurring in three distinctive phases. Phases are elaborated below<ref name="pmid3652593">{{cite journal |vauthors=Neviaser RJ, Neviaser TJ |title=The frozen shoulder. Diagnosis and management |journal=Clin Orthop Relat Res |volume= |issue=223 |pages=59–64 |date=October 1987 |pmid=3652593 |doi= |url=}}</ref><ref name="pmid28405218">{{cite journal |vauthors=Le HV, Lee SJ, Nazarian A, Rodriguez EK |title=Adhesive capsulitis of the shoulder: review of pathophysiology and current clinical treatments |journal=Shoulder Elbow |volume=9 |issue=2 |pages=75–84 |date=April 2017 |pmid=28405218 |pmc=5384535 |doi=10.1177/1758573216676786 |url=}}</ref>: | |||
*Adhesive capsulitis has clinical features | **Stage 1 or [[Inflammatory]] phase or [[Painful]] phase: Acute onset of pain with minimal limitation of joint in first three months of [[Frozen shoulder (patient information)|frozen should]]<nowiki/>er. | ||
**Stage 1 or Inflammatory phase or Painful phase: Acute onset of pain with minimal limitation of joint in first three months of frozen | **Stage 2 or [[Synovial]] [[proliferation]] phase or Freezing phase: from three to nine months there may be pain with severe [[intensity]] with decreased [[Range of motion|range]] of active and passive motion. | ||
**Stage 2 or Synovial proliferation phase or Freezing phase: from three to nine months there may be pain with severe intensity with decreased range of active and passive motion. | **Stage 3 or [[Maturation]] phase with [[Collagenous fibers|collagenous]] tissue deposition or [[Frozen shoulder (patient information)|Frozen]] or [[Transitional|transitional p]]<nowiki/>hase: Marked [[stiffness]] with decreased natural swinging of [[upper extremity]] in next ninth to fourteenth month of diagnosis. | ||
**Stage 3 or Maturation phase with collagenous tissue deposition or Frozen or transitional | **Stage 4 or [[Chronic]] phase or Thawing phase: Frozen shoulder may resolve spontaneously, thus R j Neviaser and T J Neviaser called it thawing phase, but in recent studies it was shown that it may persist as chronic phase. | ||
**Stage 4 or Chronic phase or Thawing phase: Frozen shoulder may resolve spontaneously, thus R j Neviaser and T J Neviaser called it thawing phase, but in recent studies it was shown that it may persist as chronic phase. | *If left untreated, Adhesive capsulitis may progress to develop in contralateral [[Shoulder|shoulder.]] | ||
*If left untreated, Adhesive capsulitis may progress to develop in contralateral shoulder. | *Common complications of adhesive capsulitis include [[pain]] and [[Stiffness|stiffn]]<nowiki/>ess for long duration, [[Biceps|Bicep tendon]] rupture, [[Humeral|Humeral bo]]<nowiki/>ne fracture. | ||
*Common complications of adhesive capsulitis include pain and | |||
*Prognosis is generally good and it may resolved within one to three years spontaneously or if treatment is given early with capsulotomy. | *Prognosis is generally good and it may resolved within one to three years spontaneously or if treatment is given early with capsulotomy. | ||
== Diagnosis == | ==Diagnosis== | ||
===Diagnostic Criteria=== | ===Diagnostic Criteria=== | ||
=== | *The diagnosis of [[Adhesive capsulitis of shoulder (Patient information)|adhesive capsulitis]] is a [[Diagnosis|diagnosi]]<nowiki/>s of exclusion and is made when the following diagnostic criteria are met after evaluating four components according to the [[Orthopedics|Orthopedic]] department of the APTA's recent guideline: <ref name="urlwww.orthopt.org">{{cite web |url=https://www.orthopt.org/uploads/content_files/ICF/Updated_Guidelines/Shoulder_Guidelines_AdhesiveCapsulitis_JOSPT_May_2013.pdf |title=www.orthopt.org |format= |work= |accessdate=}}</ref>: | ||
*Symptoms of adhesive capsulitis may include the following: | :*Evaluation or [[Intervention (counseling)|Intervention]] Component 1 : [[Screening|Screenin]]<nowiki/>g for other [[medical]] conditions. | ||
:*Diffuse Pain and stiffness of shoulder | :*Evaluation or [[Intervention (counseling)|Intervention]] Component 2 : Differentiating the [[diagnosis]] with [[sign/symptom]]<nowiki/>s and evaluating [[sign and symptoms]] accordingly. | ||
:*Loss of range of motion actively and passively with limited overhead activity | :*Evaluation or [[Intervention (counseling)|Intervention]] Component 3 : Identify the level of [[Irritation|irascibility]]. | ||
:*Evaluation or [[Intervention (counseling)|Intervention]] Component 4 : [[Treatment]] and other required [[Intervention (counseling)|intervention]]<nowiki/>s in an appropriate manner. | |||
===Symptoms=== | |||
*Symptoms of [[Adhesive capsulitis of shoulder (Patient information)|adhesive capsulitis]] may include the following: | |||
:*Diffuse [[Pain]] and [[stiffness]] of [[shoulder]] | |||
:*Loss of [[range of motion]] actively and passively with limited overhead activity | |||
:*Loss of natural swing of arm | :*Loss of natural swing of arm | ||
:*Weakness of affected upper extremity | :*Weakness of affected upper extremity | ||
=== Physical Examination === | *[[Adhesive capsulitis of shoulder (Patient information)|Adhesive capsulitis]] has clinical features occurring in three distinctive phases. Phases are elaborated below<ref name="pmid3652593">{{cite journal |vauthors=Neviaser RJ, Neviaser TJ |title=The frozen shoulder. Diagnosis and management |journal=Clin Orthop Relat Res |volume= |issue=223 |pages=59–64 |date=October 1987 |pmid=3652593 |doi= |url=}}</ref><ref name="pmid28405218">{{cite journal |vauthors=Le HV, Lee SJ, Nazarian A, Rodriguez EK |title=Adhesive capsulitis of the shoulder: review of pathophysiology and current clinical treatments |journal=Shoulder Elbow |volume=9 |issue=2 |pages=75–84 |date=April 2017 |pmid=28405218 |pmc=5384535 |doi=10.1177/1758573216676786 |url=}}</ref>: | ||
*Physician should examine patient by measuring The ASES/The DASH/The SPADI/The Constant score. Physical examination may be remarkable for following signs: | **Stage 1 or [[Inflammatory]] phase or [[Painful]] phase: Acute onset of pain with minimal limitation of joint in first three months of [[Frozen shoulder (patient information)|frozen should]]<nowiki/>er. | ||
:*Mild atrophy of deltoid | **Stage 2 or [[Synovial]] [[proliferation]] phase or Freezing phase: from three to nine months there may be pain with severe [[intensity]] with decreased [[Range of motion|range]] of active and passive motion. | ||
:*Poorly localized diffuse tenderness at shoulder | **Stage 3 or [[Maturation]] phase with [[Collagenous fibers|collagenous]] tissue deposition or [[Frozen shoulder (patient information)|Frozen]] or [[Transitional|transitional p]]<nowiki/>hase: Marked [[stiffness]] with decreased natural swinging of [[upper extremity]] in next ninth to fourteenth month of diagnosis. | ||
:*Loss of | **Stage 4 or [[Chronic]] phase or Thawing phase: Frozen shoulder may resolve spontaneously, thus R j Neviaser and T J Neviaser called it thawing phase, but in recent studies it was shown that it may persist as chronic phase. | ||
:*Complete loss of external | |||
===Physical Examination=== | |||
*[[Physician]] should examine patient by measuring The ASES/The [[DASH prediction score|DASH]]/The SPADI/The Constant score. [[Physical examination]] may be remarkable for following signs: | |||
:*Mild [[atrophy]] of [[deltoid muscle]] and supraspinatous muscle with adducted, internally rotated arm on [[Inspection (medicine)|inspec]]<nowiki/>tion. | |||
:*Poorly localized diffuse tenderness at [[Shoulder joint|shoulder join]]<nowiki/>t on [[palpation]]. | |||
:*Loss of [[range of motion]] actively and passively at [[shoulder joint]]. | |||
:*Complete loss of [[External rotation|external rotatio]]<nowiki/>n. | |||
=== Laboratory Findings === | ===Laboratory Findings=== | ||
*There are no specific laboratory findings associated with adhesive capsulitis as diagnosis is clinical in additional confirmatory imaging | |||
*There are no specific [[Laboratory findings template|laboratory findings]] associated with [[Adhesive capsulitis of shoulder (Patient information)|adhesive capsulitis]] as diagnosis is clinical in additional confirmatory imaging findings. | |||
===Electrocardiogram=== | ===Electrocardiogram=== | ||
There are no ECG findings associated with adhesive | There are no ECG findings associated with [[Adhesive capsulitis of shoulder (Patient information)|adhesive capsu]]<nowiki/>litis. | ||
===X-ray=== | ===X-ray=== | ||
| Line 120: | Line 137: | ||
===Echocardiography or Ultrasound=== | ===Echocardiography or Ultrasound=== | ||
Musculoskeletal ultrasound may be helpful in the diagnosis of adhesive capsulitis. Findings on an MSK ultrasound diagnostic of adhesive capsulitis include thick coracohumeral | [[Diagnostic musculoskeletal ultrasound|Musculoskeletal ultrasound]] may be helpful in the diagnosis of [[Adhesive capsulitis of shoulder (Patient information)|adhesive capsulitis]]. Findings on an [[Diagnostic musculoskeletal ultrasound|MSK ultrasound]] diagnostic of [[Adhesive capsulitis of shoulder (Patient information)|adhesive capsulitis]] include thick [[Coracohumeral ligament|coracohumeral ligame]]<nowiki/>nt, fluid effusion surrounding tendon from long head of [[biceps]]. | ||
===CT scan=== | ===CT scan=== | ||
Coronal oblique CT arthrography scan may be helpful in the diagnosis of adhesive | Coronal oblique [[Computed tomography|CT arthrography]] scan may be helpful in the diagnosis of [[Adhesive capsulitis of shoulder (Patient information)|adhesive capsuli]]<nowiki/>tis. Findings on CT scan suggestive of [[Adhesive capsulitis of shoulder (Patient information)|adhesive capsuliti]]<nowiki/>s include thick synovial capsule, resorption of subchondral humeral head, thin recess in [[axilla]]<ref name="pmid28409175">{{cite journal |vauthors=Cerny M, Omoumi P, Larbi A, Manicourt D, Perozziello A, Lecouvet FE, Berg BV, Dallaudière B |title=CT arthrography of adhesive capsulitis of the shoulder: Are MR signs applicable? |journal=Eur J Radiol Open |volume=4 |issue= |pages=40–44 |date=2017 |pmid=28409175 |pmc=5379909 |doi=10.1016/j.ejro.2017.03.002 |url=}}</ref>. | ||
===MRI=== | ===MRI=== | ||
Shoulder MRI and MRA may be helpful in the diagnosis of adhesive capsulitis. Findings on MRI and MRA diagnostic of adhesive capsulitis include decreased rotator interval(RI), enhancement of rotator interval, dysfunctional tissue, thickening of capsules and coracohumeral ligament, axillary recess | Shoulder [[MRI]] and [[Magnetic resonance angiography|MRA]] may be helpful in the diagnosis of [[Adhesive capsulitis of shoulder (Patient information)|adhesive capsulitis]]. Findings on [[Magnetic resonance imaging|MRI]] and [[Magnetic resonance angiography|MRA]] diagnostic of [[Adhesive capsulitis of shoulder (Patient information)|adhesive capsulitis]] include decreased rotator interval(RI), enhancement of rotator interval, dysfunctional tissue, thickening of [[capsules]] and [[Coracohumeral ligament|coracohumeral]] ligament, [[axillary recess]] v[[Volume depletion|olume depletion]], axillary recess width reduction, T2 [[Magnetic resonance imaging|MRI]] showing enhancement of [[Glenohumeral ligaments|glenohumeral ligament]] inferiorly<ref name="pmid28409175">{{cite journal |vauthors=Cerny M, Omoumi P, Larbi A, Manicourt D, Perozziello A, Lecouvet FE, Berg BV, Dallaudière B |title=CT arthrography of adhesive capsulitis of the shoulder: Are MR signs applicable? |journal=Eur J Radiol Open |volume=4 |issue= |pages=40–44 |date=2017 |pmid=28409175 |pmc=5379909 |doi=10.1016/j.ejro.2017.03.002 |url=}}</ref><ref name="pmid22623575">{{cite journal |vauthors=Gondim Teixeira PA, Balaj C, Chanson A, Lecocq S, Louis M, Blum A |title=Adhesive capsulitis of the shoulder: value of inferior glenohumeral ligament signal changes on T2-weighted fat-saturated images |journal=AJR Am J Roentgenol |volume=198 |issue=6 |pages=W589–96 |date=June 2012 |pmid=22623575 |doi=10.2214/AJR.11.7453 |url=}}</ref>. | ||
===Other Imaging Findings=== | ===Other Imaging Findings=== | ||
Bone scan with technetium-99m contrast may be helpful in the diagnosis of adhesive capsulitis. Findings on an Bone scan with technetium-99m contrast suggestive of/diagnostic of adhesive capsulitis include 2% uptake in affected part<ref name="pmid16356983">{{cite journal |vauthors=Dias R, Cutts S, Massoud S |title=Frozen shoulder |journal=BMJ |volume=331 |issue=7530 |pages=1453–6 |date=December 2005 |pmid=16356983 |pmc=1315655 |doi=10.1136/bmj.331.7530.1453 |url=}}</ref>. | [[Bone scan]] with [[Technetium-99m|technetium-99m contrast]] may be helpful in the diagnosis of [[Adhesive capsulitis of shoulder (Patient information)|adhesive capsulitis]]. Findings on an [[Bone scan]] with [[technetium-99m]] contrast suggestive of/diagnostic of [[Adhesive capsulitis of shoulder (Patient information)|adhesive capsulitis]] include 2% uptake in affected part<ref name="pmid16356983">{{cite journal |vauthors=Dias R, Cutts S, Massoud S |title=Frozen shoulder |journal=BMJ |volume=331 |issue=7530 |pages=1453–6 |date=December 2005 |pmid=16356983 |pmc=1315655 |doi=10.1136/bmj.331.7530.1453 |url=}}</ref>. | ||
=== Other Diagnostic Studies === | ===Other Diagnostic Studies=== | ||
*There are no other diagnostic studies suggestive of [[Adhesive capsulitis of shoulder (Patient information)|adhesive capsulitis]]. | |||
* | |||
=== Surgery === | ==Treatment== | ||
*Stage 3 treatment are given with exercise with aggressive | ===Medical Therapy=== | ||
*The mainstay of therapy for [[Adhesive capsulitis of shoulder (Patient information)|adhesive capsulitis]] is [[supportive treatment]] with [[Non-steroidal anti-inflammatory drug|NSAIDs]] and other [[analgesics]]. | |||
*Stage 2 treatment are given with [[Non-steroidal anti-inflammatory drug|NSAIDs]], [[physical therapy]], [[intra-articular injection]] with steroid. | |||
===Surgery=== | |||
*Stage 3 [[treatment]] are given with [[exercise]] with aggressive [[Stretching|stretchin]]<nowiki/>g, [[local anesthesia]] manipulation, [[capsulotomy]] in surgical release. | |||
=== Prevention === | ===Prevention=== | ||
*There are no primary preventive measures available for adhesive capsulitis. | |||
*Secondary prevention can be taken as following: | *There are no [[Primary prevention|primary preventive]] measures available for [[Adhesive capsulitis of shoulder (Patient information)|adhesive capsulitis]]. | ||
**Early treatment and maintenance of chronic illness like diabetes mellitus, SLE, RA. | *[[Secondary prevention]] can be taken as following: | ||
**Daily exposure of exercise with shoulder, neck, back muscle, tendon stretching. | **Early [[treatment]] and maintenance of chronic illness like [[diabetes mellitus]], [[SLE]], [[Rheumatoid arthritis|RA]]. | ||
**Daily exposure of [[Physical exercise|exercise]] with [[shoulder]], [[neck]], [[back]] [[muscle]], [[tendon]] [[stretching]]. | |||
**Avoid postures those are detrimental to health, using chair and table of accurate height and distance. | **Avoid postures those are detrimental to health, using chair and table of accurate height and distance. | ||
**Development of habit of taking nutritious food with accurate | **Development of habit of taking nutritious food with accurate amount of [[vitamins]] and [[minerals]]. | ||
**Early practice of ROM exercise postoperatively. | **Early practice of [[Range of motion|ROM]] exercise postoperatively. | ||
==Related Chapters== | ==Related Chapters== | ||
* [[Calcific Tendonitis]] | |||
*[[Calcific Tendonitis]] | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Latest revision as of 04:11, 25 February 2021
Template:Adhesive Capsulitis of Shoulder
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Marufa Marium, M.B.B.S[2]
For patient information, click here
Synonyms and keywords: Frozen shoulder syndrome; Adhesive capsulitis; Duplay Bursitis, Scapulohumeral periarthritis; Arthofibrosis; Shoulder pain; Shoulder stiffness; Shoulder Capsulitis.
Overview
Adhesive capsulitis is an inflammatory insult to glenohumeral joint limiting range of motion actively and passively due to pain and stiffness of shoulder joint. The range of motion is debilitated due to inflammation and fibrosis of adhesive bursa due to primary and secondary causes.
Historical Perspective
- Adhesive capsulitis was first discovered by Simon Emmanuel Duplay, a French surgeon, in 1872 who introduced the term 'scapulohumeral periarthritis' to identify painful shoulder with normal preservation of imaging findings. In 1934 Earnest Codman termed it as Frozen Shoulder' as there was loss of range of motion at shoulder joint. Later in 1945, due to the involvement of inflammation of capsule leading to fibrosis of bursa was elaborated by Julius Neviaser, he named it 'Adhesive capsulitis'.[1][2]
Classification
- Adhesive capsulitis may be classified according to etiology into two groups:
- Primary or Idiopathic:
- Adhesive capsulitis can occur spontaneously without concurrent shoulder joint abnormality or inciting factors.
- Secondary:
- Adhesive capsulitis can present due to preexistent shoulder joint dysfunction for instances glenohumeral joint dislocation with fracture of periarticular region, joint trauma, arthroscopic surgery to shoulder joint, arthroplasty or rotator cuff injury repair. Diabetes mellitus is the most common secondary cause, other than this dysfunctional thyroid gland, adrenal insufficiency, fibromatosis resulting in dupuytren's contracture, cerebrovascular attack, respiratory disease, cardiovascular disease, parkinson's disease, surgery to neck/brain/heart may predispose adhesive capsulitis. [3][4][2][5][6]
Pathophysiology
- The pathogenesis of adhesive capsulitis is characterized by inflammation and fibrosis which is elaborated several pathways mentioned below.
- In the beginning it was thought myofibroblasts are playing role in fibrotic pathway. low levels of metalloproteinases (MMP 1,2, 14) and elevated expression are shown by tissue inhibitor of metalloproteinases (TIMP 1 or 2) for instances resulting in ECM imbalances and fibrosis.[7]
- Inflammatory process involving IL-1s (Both alpha/beta), TNF- alpha, Cyclooxygenases(COX-1 or COX-2) leading to accumulation of macrophages, T and B cells, mast cells are recently thought to have role adhesive capsulitis. [8]
- Molecules like ICAM-1, SNP(single- peptide polymorphism of Interleukin-6), metalloproteinases-3, IGF-2, Beta catenin are involved in genetic association with adhesive capsulitis.[1] [9] [10]
- In recent studies the intolerable pain of adhesive capsulitis is explained by the involvement of nerve invasion by nerve growth factor receptor p75. VEGF, PGP9.5(Protein gene product 9.5), MAPK(mitogen-activated protein kinases)/ENK pathway and MAPK/JNK, Beta-1 integrin(CD19), CD34, NF-kB, TGF- beta, GAP43(growth associated protein 43) are elevated in pathogenesis in Adhesive capsulitis.[11][12] [13][8]
- On gross pathology, inflammation, congestion, fibrosis of capsule are characteristic findings of adhesive capsulitis.[8]
- On microscopic histopathological analysis, cellular infiltration with accumulation of macrophages, T and B cells, mast cells are characteristic findings of adhesive capsulitis.[8]
Causes
Adhesive Capsulitis may be caused by primarily or Secondarily. Diabetes Mellitus is most common cause of adhesive capsulitis among the secondary cause. The etiologies are:
- Primary or Idiopathic:
- Adhesive capsulitis can occur spontaneously without concurrent shoulder joint abnormality or inciting factors
- Secondary:
- Adhesive capsulitis can present due to preexistent shoulder joint dysfunction for instances glenohumeral joint dislocation with fracture of periarticular region, joint trauma, arthroscopic surgery to shoulder joint, arthroplasty or rotator cuff injury repair. [3][4] Systemic illnesses are associated in causing secondary adhesive capsulitis, plays greater role than preexisting joint dysfunction. Diabetes mellitus is the most common secondary cause, other than this dysfunctional thyroid gland, adrenal insufficiency, fibromatosis resulting in dupuytren's contracture, cerebrovascular attack, respiratory disease, cardiovascular disease, parkinson's disease, surgery to neck/brain/heart may predispose adhesive capsulitis. [3][4][2][5][6]
- Primary or Idiopathic:
Differentiating Adhesive capsulitis from other Diseases
For further information about the differential diagnosis, click here.
Epidemiology and Demographics
- The prevalence of adhesive capsulitis is approximately 2 to 5.3 % in individuals worldwide.[14]
- The incidence of adhesive capsulitis was estimated to be 3 to 5% with 20% cases related with diabetes mellitus.[1]
Age
- Adhesive capsulitis is more commonly observed among patients aged 40 to 59 years with an average age of 55 years old.[15]
Gender
- Female are more commonly affected with adhesive capsulitis than male comprising of 70% of total cases.[16]
Race
- People from African American and Hispanic or Latino race are more likely to have association with Adhesive capsulitis.[17]
Risk Factors
- Common risk factors in the development of adhesive capsulitis are mentioned below[3][4][2][5][6]:
- Gender: female
- Age: 40-59 years
- Diabetes Mellitus
- Preexistent shoulder joint dysfunction
- History of trauma
- Immobilization
- HLA-B27
- Dysfunctional thyroid gland
- Adrenal insufficiency
- Fibromatosis resulting in dupuytren's contracture
- Cerebrovascular attack, respiratory disease, cardiovascular disease
- Parkinson's disease
- surgery to neck/brain/heart
Natural History, Complications and Prognosis
- Adhesive capsulitis has clinical features occurring in three distinctive phases. Phases are elaborated below[18][1]:
- Stage 1 or Inflammatory phase or Painful phase: Acute onset of pain with minimal limitation of joint in first three months of frozen shoulder.
- Stage 2 or Synovial proliferation phase or Freezing phase: from three to nine months there may be pain with severe intensity with decreased range of active and passive motion.
- Stage 3 or Maturation phase with collagenous tissue deposition or Frozen or transitional phase: Marked stiffness with decreased natural swinging of upper extremity in next ninth to fourteenth month of diagnosis.
- Stage 4 or Chronic phase or Thawing phase: Frozen shoulder may resolve spontaneously, thus R j Neviaser and T J Neviaser called it thawing phase, but in recent studies it was shown that it may persist as chronic phase.
- If left untreated, Adhesive capsulitis may progress to develop in contralateral shoulder.
- Common complications of adhesive capsulitis include pain and stiffness for long duration, Bicep tendon rupture, Humeral bone fracture.
- Prognosis is generally good and it may resolved within one to three years spontaneously or if treatment is given early with capsulotomy.
Diagnosis
Diagnostic Criteria
- The diagnosis of adhesive capsulitis is a diagnosis of exclusion and is made when the following diagnostic criteria are met after evaluating four components according to the Orthopedic department of the APTA's recent guideline: [19]:
- Evaluation or Intervention Component 1 : Screening for other medical conditions.
- Evaluation or Intervention Component 2 : Differentiating the diagnosis with sign/symptoms and evaluating sign and symptoms accordingly.
- Evaluation or Intervention Component 3 : Identify the level of irascibility.
- Evaluation or Intervention Component 4 : Treatment and other required interventions in an appropriate manner.
Symptoms
- Symptoms of adhesive capsulitis may include the following:
- Diffuse Pain and stiffness of shoulder
- Loss of range of motion actively and passively with limited overhead activity
- Loss of natural swing of arm
- Weakness of affected upper extremity
- Adhesive capsulitis has clinical features occurring in three distinctive phases. Phases are elaborated below[18][1]:
- Stage 1 or Inflammatory phase or Painful phase: Acute onset of pain with minimal limitation of joint in first three months of frozen shoulder.
- Stage 2 or Synovial proliferation phase or Freezing phase: from three to nine months there may be pain with severe intensity with decreased range of active and passive motion.
- Stage 3 or Maturation phase with collagenous tissue deposition or Frozen or transitional phase: Marked stiffness with decreased natural swinging of upper extremity in next ninth to fourteenth month of diagnosis.
- Stage 4 or Chronic phase or Thawing phase: Frozen shoulder may resolve spontaneously, thus R j Neviaser and T J Neviaser called it thawing phase, but in recent studies it was shown that it may persist as chronic phase.
Physical Examination
- Physician should examine patient by measuring The ASES/The DASH/The SPADI/The Constant score. Physical examination may be remarkable for following signs:
- Mild atrophy of deltoid muscle and supraspinatous muscle with adducted, internally rotated arm on inspection.
- Poorly localized diffuse tenderness at shoulder joint on palpation.
- Loss of range of motion actively and passively at shoulder joint.
- Complete loss of external rotation.
Laboratory Findings
- There are no specific laboratory findings associated with adhesive capsulitis as diagnosis is clinical in additional confirmatory imaging findings.
Electrocardiogram
There are no ECG findings associated with adhesive capsulitis.
X-ray
An x-ray might be helpful in aiding to diagnose chronic case of Adhesive capsulitis and to rule out other causes of stiff shoulder. Findings on an x-ray suggestive of chronic adhesive capsulitis include disuse osteopenia [20].
Echocardiography or Ultrasound
Musculoskeletal ultrasound may be helpful in the diagnosis of adhesive capsulitis. Findings on an MSK ultrasound diagnostic of adhesive capsulitis include thick coracohumeral ligament, fluid effusion surrounding tendon from long head of biceps.
CT scan
Coronal oblique CT arthrography scan may be helpful in the diagnosis of adhesive capsulitis. Findings on CT scan suggestive of adhesive capsulitis include thick synovial capsule, resorption of subchondral humeral head, thin recess in axilla[21].
MRI
Shoulder MRI and MRA may be helpful in the diagnosis of adhesive capsulitis. Findings on MRI and MRA diagnostic of adhesive capsulitis include decreased rotator interval(RI), enhancement of rotator interval, dysfunctional tissue, thickening of capsules and coracohumeral ligament, axillary recess volume depletion, axillary recess width reduction, T2 MRI showing enhancement of glenohumeral ligament inferiorly[21][22].
Other Imaging Findings
Bone scan with technetium-99m contrast may be helpful in the diagnosis of adhesive capsulitis. Findings on an Bone scan with technetium-99m contrast suggestive of/diagnostic of adhesive capsulitis include 2% uptake in affected part[2].
Other Diagnostic Studies
- There are no other diagnostic studies suggestive of adhesive capsulitis.
Treatment
Medical Therapy
- The mainstay of therapy for adhesive capsulitis is supportive treatment with NSAIDs and other analgesics.
- Stage 2 treatment are given with NSAIDs, physical therapy, intra-articular injection with steroid.
Surgery
- Stage 3 treatment are given with exercise with aggressive stretching, local anesthesia manipulation, capsulotomy in surgical release.
Prevention
- There are no primary preventive measures available for adhesive capsulitis.
- Secondary prevention can be taken as following:
- Early treatment and maintenance of chronic illness like diabetes mellitus, SLE, RA.
- Daily exposure of exercise with shoulder, neck, back muscle, tendon stretching.
- Avoid postures those are detrimental to health, using chair and table of accurate height and distance.
- Development of habit of taking nutritious food with accurate amount of vitamins and minerals.
- Early practice of ROM exercise postoperatively.
Related Chapters
References
- ↑ 1.0 1.1 1.2 1.3 1.4 Le HV, Lee SJ, Nazarian A, Rodriguez EK (April 2017). "Adhesive capsulitis of the shoulder: review of pathophysiology and current clinical treatments". Shoulder Elbow. 9 (2): 75–84. doi:10.1177/1758573216676786. PMC 5384535. PMID 28405218.
- ↑ 2.0 2.1 2.2 2.3 2.4 Dias R, Cutts S, Massoud S (December 2005). "Frozen shoulder". BMJ. 331 (7530): 1453–6. doi:10.1136/bmj.331.7530.1453. PMC 1315655. PMID 16356983.
- ↑ 3.0 3.1 3.2 3.3 Bailie DS, Llinas PJ, Ellenbecker TS (January 2008). "Cementless humeral resurfacing arthroplasty in active patients less than fifty-five years of age". J Bone Joint Surg Am. 90 (1): 110–7. doi:10.2106/JBJS.F.01552. PMID 18171964.
- ↑ 4.0 4.1 4.2 4.3 McAlister I, Sems SA (April 2016). "Arthrofibrosis After Periarticular Fracture Fixation". Orthop Clin North Am. 47 (2): 345–55. doi:10.1016/j.ocl.2015.09.003. PMID 26772943.
- ↑ 5.0 5.1 5.2 Griggs SM, Ahn A, Green A (October 2000). "Idiopathic adhesive capsulitis. A prospective functional outcome study of nonoperative treatment". J Bone Joint Surg Am. 82 (10): 1398–407. PMID 11057467.
- ↑ 6.0 6.1 6.2 Bunker TD, Anthony PP (September 1995). "The pathology of frozen shoulder. A Dupuytren-like disease". J Bone Joint Surg Br. 77 (5): 677–83. PMID 7559688.
- ↑ Lubis AM, Lubis VK (July 2013). "Matrix metalloproteinase, tissue inhibitor of metalloproteinase and transforming growth factor-beta 1 in frozen shoulder, and their changes as response to intensive stretching and supervised neglect exercise". J Orthop Sci. 18 (4): 519–27. doi:10.1007/s00776-013-0387-0. PMID 23604641.
- ↑ 8.0 8.1 8.2 8.3 Hand GC, Athanasou NA, Matthews T, Carr AJ (July 2007). "The pathology of frozen shoulder". J Bone Joint Surg Br. 89 (7): 928–32. doi:10.1302/0301-620X.89B7.19097. PMID 17673588.
- ↑ Kim YS, Kim JM, Lee YG, Hong OK, Kwon HS, Ji JH (February 2013). "Intercellular adhesion molecule-1 (ICAM-1, CD54) is increased in adhesive capsulitis". J Bone Joint Surg Am. 95 (4): e181–8. doi:10.2106/JBJS.K.00525. PMID 23426775.
- ↑ Raykha CN, Crawford JD, Burry AF, Drosdowech DS, Faber KJ, Gan BS, O'Gorman DB (August 2014). "IGF2 expression and β-catenin levels are increased in Frozen Shoulder Syndrome". Clin Invest Med. 37 (4): E262–7. doi:10.25011/cim.v37i4.21733. PMID 25090267.
- ↑ Kanbe K, Inoue K, Inoue Y, Chen Q (January 2009). "Inducement of mitogen-activated protein kinases in frozen shoulders". J Orthop Sci. 14 (1): 56–61. doi:10.1007/s00776-008-1295-6. PMC 2893737. PMID 19214689.
- ↑ Xu Y, Bonar F, Murrell GA (October 2012). "Enhanced expression of neuronal proteins in idiopathic frozen shoulder". J Shoulder Elbow Surg. 21 (10): 1391–7. doi:10.1016/j.jse.2011.08.046. PMID 22005128.
- ↑ Watson RS, Gouze E, Levings PP, Bush ML, Kay JD, Jorgensen MS, Dacanay EA, Reith JW, Wright TW, Ghivizzani SC (November 2010). "Gene delivery of TGF-β1 induces arthrofibrosis and chondrometaplasia of synovium in vivo". Lab Invest. 90 (11): 1615–27. doi:10.1038/labinvest.2010.145. PMC 3724510. PMID 20697373.
- ↑ "Adhesive Capsulitis - StatPearls - NCBI Bookshelf".
- ↑ Boyle-Walker KL, Gabard DL, Bietsch E, Masek-VanArsdale DM, Robinson BL (1997). "A profile of patients with adhesive capsulitis". J Hand Ther. 10 (3): 222–8. doi:10.1016/s0894-1130(97)80025-7. PMID 9268913.
- ↑ Sheridan MA, Hannafin JA (October 2006). "Upper extremity: emphasis on frozen shoulder". Orthop Clin North Am. 37 (4): 531–9. doi:10.1016/j.ocl.2006.09.009. PMID 17141009.
- ↑ Kingston K, Curry EJ, Galvin JW, Li X (August 2018). "Shoulder adhesive capsulitis: epidemiology and predictors of surgery". J Shoulder Elbow Surg. 27 (8): 1437–1443. doi:10.1016/j.jse.2018.04.004. PMID 29807717.
- ↑ 18.0 18.1 Neviaser RJ, Neviaser TJ (October 1987). "The frozen shoulder. Diagnosis and management". Clin Orthop Relat Res (223): 59–64. PMID 3652593.
- ↑ "www.orthopt.org" (PDF).
- ↑ Neviaser AS, Neviaser RJ (September 2011). "Adhesive capsulitis of the shoulder". J Am Acad Orthop Surg. 19 (9): 536–42. doi:10.5435/00124635-201109000-00004. PMID 21885699.
- ↑ 21.0 21.1 Cerny M, Omoumi P, Larbi A, Manicourt D, Perozziello A, Lecouvet FE, Berg BV, Dallaudière B (2017). "CT arthrography of adhesive capsulitis of the shoulder: Are MR signs applicable?". Eur J Radiol Open. 4: 40–44. doi:10.1016/j.ejro.2017.03.002. PMC 5379909. PMID 28409175.
- ↑ Gondim Teixeira PA, Balaj C, Chanson A, Lecocq S, Louis M, Blum A (June 2012). "Adhesive capsulitis of the shoulder: value of inferior glenohumeral ligament signal changes on T2-weighted fat-saturated images". AJR Am J Roentgenol. 198 (6): W589–96. doi:10.2214/AJR.11.7453. PMID 22623575.