Adhesive capsulitis of shoulder: Difference between revisions

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{{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 active and passive range of motion due to pain and stiffness of shoulder joint. The active and passive range of motion is debilitated due to inflammation and fibrosis of adhesive bursa due to primary and secondary causes.
[[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 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. <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>


*[[Adhesive capsulitis of shoulder (Patient information)|Adhesive capsulitis]] may be classified according to [[etiology]] into two groups:
*Primary or [[Idiopathic]]:
**[[Adhesive capsulitis of shoulder (Patient information)|Adhesive capsulitis]] can occur spontaneously without concurrent [[shoulder joint]] abnormality or inciting factors.
*Secondary:
**[[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==
*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 (MMPs) like MMP-14, MMP-1, MMP-2 and increased expression of tissue inhibitor of metalloproteinases (TIMPs) for instances TIMP-1, TIMP-2 resulting in 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 alpha, IL-1 beta, TNF- alpha, COX-1 and COX-2 leading to accumulation of macrophages, T and B cells, mast cells are recently thought to have role 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, SNP(single- peptide polymorphism of Interleukin-6), metalloproteinases-3, IGF-2, Beta catenin are involved in genetic association with 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 is explained by the involvement of nerve invasion by nerve growth factor receptor p75. VEGF, MAPK(mitogen-activated protein kinases)/ENK pathway and MAPK/JNK, Beta-1 integrin(CD19), CD34,PGP9.5(Protein gene product 9.5), GAP43(growth associated protein 43), NF-kB, TGF- beta are elevated in pathogenesis in 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, congestion, fibrosis of capsule are characteristic findings of 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>
*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   are characteristic findings of 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>
**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==
Disease name] may be caused by [cause1], [cause2], or [cause3].
[[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:


OR
**Primary or [[Idiopathic]]:
***[[Adhesive capsulitis of shoulder (Patient information)|Adhesive capsulitis]] can occur spontaneously without concurrent shoulder joint abnormality or inciting factors
**Secondary:
***[[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>


Common causes of [disease] include [cause1], [cause2], and [cause3].
==Differentiating Adhesive capsulitis from other Diseases==


OR
For further information about the differential diagnosis, click [[Disease_Name differential diagnosis|here]].


The most common cause of [disease name] is [cause 1]. Less common causes of [disease name] include [cause 2], [cause 3], and [cause 4].
==Epidemiology and Demographics==
 
OR
 
The cause of [disease name] has not been identified. To review risk factors for the development of [disease name], click [[Pericarditis causes#Overview|here]].
==Differentiating [disease name] from other Diseases==


For further information about the differential diagnosis, click [[Disease_Name differential diagnosis|here]].
*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>


==Epidemiology and Demographics==
* The prevalence of [disease name] is approximately [number or range] per 100,000 individuals worldwide.
* In [year], the incidence of [disease name] was estimated to be [number or range] cases per 100,000 individuals in [location].
===Age===
===Age===
*Patients of all age groups may develop [disease name].
*[Disease name] is more commonly observed among patients aged [age range] years old.
*[Disease name] is more commonly observed among [elderly patients/young patients/children].
===Gender===
*[Disease name] affects men and women equally.
*[Gender 1] are more commonly affected with [disease name] than [gender 2].
* The [gender 1] to [Gender 2] ratio is approximately [number > 1] to 1.
===Race===
*There is no racial predilection for [disease name].
*[Disease name] usually affects individuals of the [race 1] race.
*[Race 2] individuals are less likely to develop [disease name].


==Risk Factors==
*[[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>
*Common risk factors in the development of [disease name] are [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].


== Natural History, Complications and Prognosis==
===Gender===  
*The majority of patients with [disease name] remain asymptomatic for [duration/years].
*Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
*If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
*Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
*Prognosis is generally [excellent/good/poor], and the [1/5/10­year mortality/survival rate] of patients with [disease name] is approximately [#%].


== Diagnosis ==
*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>
===Diagnostic Criteria===
*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met:
:*[criterion 1]
:*[criterion 2]
:*[criterion 3]
:*[criterion 4]
   
   
=== Symptoms ===
===Race===
*[Disease name] is usually asymptomatic.
*Symptoms of [disease name] may include the following:
:*[symptom 1]
:*[symptom 2]
:*[symptom 3]
:*[symptom 4]
:*[symptom 5]
:*[symptom 6]
=== Physical Examination ===
*Patients with [disease name] usually appear [general appearance].
*Physical examination may be remarkable for:
:*[finding 1]
:*[finding 2]
:*[finding 3]
:*[finding 4]
:*[finding 5]
:*[finding 6]


=== Laboratory Findings ===
*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>
*There are no specific laboratory findings associated with [disease name].


*A  [positive/negative] [test name] is diagnostic of [disease name].
==Risk Factors==
*An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of [disease name].
*Other laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
===Electrocardiogram===
There are no ECG findings associated with [disease name].


OR
*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
**Age: 40-59 years
**[[Diabetes mellitus|Diabetes Mellitus]]
**Preexistent [[shoulder joint]] dysfunction
**History of trauma
**Immobilization
**[[HLA-B27]]
**Dysfunctional [[thyroid gland]]
**[[Adrenal insufficiency]]
**[[Fibromatosis]] resulting in [[Dupuytrens contracture|dupuytren's contracture]]
**[[Cerebrovascular attack]], [[Respiratory disease|respiratory disease,]] [[cardiovascular disease]]
**[[Parkinson's disease]]
**surgery to [[neck]]/[[brain]]/[[heart]]


An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
==Natural History, Complications and Prognosis==


===X-ray===
*[[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>:
There are no x-ray findings associated with [disease name].
**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 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 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 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.]]
*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.
*Prognosis is generally good and it may resolved within one to three years spontaneously or if treatment is given early with capsulotomy.


OR
==Diagnosis==
===Diagnostic Criteria===


An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
*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>:


OR
:*Evaluation or [[Intervention (counseling)|Intervention]] Component 1 : [[Screening|Screenin]]<nowiki/>g for other [[medical]] conditions.
:*Evaluation or [[Intervention (counseling)|Intervention]] Component 2 : Differentiating the [[diagnosis]] with [[sign/symptom]]<nowiki/>s and evaluating [[sign and symptoms]] accordingly.
:*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.


There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
===Symptoms===


===Echocardiography or Ultrasound===
*Symptoms of [[Adhesive capsulitis of shoulder (Patient information)|adhesive capsulitis]] may include the following:
There are no echocardiography/ultrasound  findings associated with [disease name].


OR
:*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


Echocardiography/ultrasound  may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
*[[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>:
**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 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 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 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.


OR
===Physical Examination===


There are no echocardiography/ultrasound  findings associated with [disease name]. However, an echocardiography/ultrasound  may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
*[[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:


===CT scan===
:*Mild [[atrophy]] of [[deltoid muscle]] and supraspinatous muscle with adducted, internally rotated arm  on [[Inspection (medicine)|inspec]]<nowiki/>tion.
There are no CT scan findings associated with [disease name].
:*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.


OR
===Laboratory Findings===


[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
*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.


OR
===Electrocardiogram===
There are no ECG findings associated with [[Adhesive capsulitis of shoulder (Patient information)|adhesive capsu]]<nowiki/>litis.


There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
===X-ray===


===MRI===
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 <ref name="pmid21885699">{{cite journal |vauthors=Neviaser AS, Neviaser RJ |title=Adhesive capsulitis of the shoulder |journal=J Am Acad Orthop Surg |volume=19 |issue=9 |pages=536–42 |date=September 2011 |pmid=21885699 |doi=10.5435/00124635-201109000-00004 |url=}}</ref>.
There are no MRI findings associated with [disease name].


OR
===Echocardiography or Ultrasound===


[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
[[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]].


OR
===CT scan===
 
There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
 
===Other Imaging Findings===
There are no other imaging findings associated with [disease name].
 
OR
 
[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
=== Other Diagnostic Studies ===
*[Disease name] may also be diagnosed using [diagnostic study name].
*Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].
 
== Treatment ==
=== Medical Therapy ===
*There is no treatment for [disease name]; the mainstay of therapy is supportive care.
*The mainstay of therapy for [disease name] is [medical therapy 1] and [medical therapy 2].
*[Medical therapy 1] acts by [mechanism of action 1].
*Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].
=== Surgery ===
*Surgery is the mainstay of therapy for [disease name].
*[Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
*[Surgical procedure] can only be performed for patients with [disease stage] [disease name].
=== Prevention ===
*There are no primary preventive measures available for [disease name].
*Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
 
*Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].
 
 
==Differentiating Adhesive Capsulitis of Shoulder from other Diseases==
*Brachial plexus injury
*[[Caplan's Syndrome]]
*Cerebrovascular accident
*Cervical spinal cord injury
*[[Diabetes Mellitus]]
*[[Felty's Syndrome]]
*[[Hyperthyroidism]]
*[[Hypotriglyceridemia]]
*[[Parkinson's Disease]]
*[[Reiter's Syndrome]]
*Repetative movements
*[[Rheumatic Fever]]
*[[Rheumatoid Arthritis]]
*[[Still's Disease]]
 
==Epidemiology and Demographics==
It has an incidence of 2,400 out of every 100,000 patients per year.<ref name="pmid18043780">{{cite journal |author=Walters J, Howes F, Buchbinder R|title=Oral corticosteroids--their place in the management of adhesive capsulitis |journal=Aust Fam Physician |volume=36|issue=11 |pages=927–9 |year=2007 |pmid=18043780 |doi= |url=http://www.racgp.org.au/afp/200711/20739}}</ref>
 
==Risk Factors==
 
Most of the time there is no cause for frozen shoulder. Risk factors include:
 
* Cervical disk disease of the neck
* [[Diabetes]]
* Shoulder injury
* Shoulder surgery
* [[Open heart surgery]]
* Thyroid problems
==Natural History, Complications and Prognosis==
===Complications===
* [[Stiffness]] and pain continue even with therapy.
* The arm can break if the shoulder is moved forcefully during [[surgery]].
===Prognosis===
Treatment with [[physical therapy]] and [[NSAID]]s will usually restore motion and function of the [[shoulder]] within a year. Even untreated, the shoulder can get better by itself in 24 months.
 
After surgery restores motion, you must continue physical therapy for several weeks or months to prevent the frozen shoulder from returning. Treatment may fail if you cannot keep up with physical therapy.
 
==Diagnosis==
===History and Symptoms===
Movement of the shoulder is severely restricted. The condition is sometimes caused by injury that leads to lack of use due to [[Pain and nociception|pain]] but also often arises spontaneously with no obvious preceding trigger factor. These seemingly spontaneous cases are usually referred to as [[Idiopathic]] Frozen Shoulder. [[Rheumatism|Rheumatic disease]] progression and recent shoulder [[surgery]] can also cause a pattern of pain and limititation similar to frozen shoulder. Intermittent periods of use may cause [[inflammation]].
 
Abnormal bands of [[tissue (biology)|tissue]] ([[Adhesion (medicine)|adhesions]]) grow between the [[joint]] surfaces, restricting motion. There is also a lack of [[synovial fluid]], which normally helps the shoulder joint move by lubricating the gap between the [[humerus]] (upper arm [[bone]]) and the socket in the [[scapula]] (shoulder blade). It is this restricted space between the capsule and ball of the humerus that distinguishes adhesive capsulitis from a less complicated, painful, stiff shoulder. People with [[diabetes]], [[stroke]], [[lung disease]], [[rheumatoid arthritis]], and [[heart disease]], or who have been in an accident, are at a higher risk for frozen shoulder. Adhesive capsulitis has been indicated as a possible adverse effect of some forms of highly active antiretroviral therapy ([[HAART]]). The condition rarely appears in people under 40 years old and (at least in its idiopathic form) is much more common in women than in men (70% of patients are women aged 40-60). Frozen shoulder in diabetic patients is generally thought to be a more troublesome condition than in the non-diabetic population. <ref name="titleQuestions and Answers about Shoulder Problems">{{cite web |url=http://www.niams.nih.gov/Health_Info/Shoulder_Problems/default.asp |title=Questions and Answers about Shoulder Problems |accessdate=2008-01-28 |format= |work=}}</ref> If a diabetic patient develops frozen shoulder then the time to full recovery is often prolonged from the usual 12 month period.
 
===Physical Examination===
With a frozen shoulder, one [[sign (medicine)|sign]] is that the joint becomes so tight and stiff that it is nearly impossible to carry out simple movements, such as raising the arm.
People complain that the stiffness and pain worsen at night. Pain due to frozen shoulder is usually dull or aching. It can be worsened with attempted motion. A doctor, or therapist ([[occupational therapy|occupational]], massage or [[physical therapy|physical]]), may suspect the patient has a frozen shoulder if a [[physical examination]] reveals limited shoulder movement. Frozen shoulder can also be diagnosed if limits to the active range of motion (range of motion from active use of muscles) are the same or almost the same as the limits to the passive range of motion (range of motion from a person manipulating the arm and shoulder).
 
Physicians have described the normal course of a frozen shoulder as having three stages:<ref name="titleYour Orthopaedic Connection: Frozen Shoulder">{{cite web |url=http://orthoinfo.aaos.org/topic.cfm?topic=A00071 |title=Your Orthopaedic Connection: Frozen Shoulder |accessdate=2008-01-28 |format= |work=}}</ref>
 
* Stage one: In the "freezing" or painful stage, which may last from six weeks to nine months, the patient has a slow onset of pain. As the pain worsens, the shoulder loses motion.


* Stage two: The "frozen" or adhesive stage is marked by a slow improvement in pain, but the stiffness remains. This stage generally lasts four months to nine months.
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>.
 
* Stage three: The "thawing" or recovery, during which shoulder motion slowly returns toward normal. This generally lasts five months to 26 months.


===MRI===
===MRI===
An [[arthrogram]] or an [[MRI]] scan may confirm the diagnosis - although in practice this is rarely required. Most orthopedic specialists make the diagnosis of frozen shoulder by recognizing the typical pattern of signs and symptoms.


Shown below are MRI images from a patient with adhesive capsulitis.
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>.
<gallery>
Image:


Adhesive capsulitis 001.jpg
===Other Imaging Findings===


Image:
[[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>.


Adhesive capsulitis 001.jpg
===Other Diagnostic Studies===


</gallery>
*There are no other diagnostic studies suggestive of [[Adhesive capsulitis of shoulder (Patient information)|adhesive capsulitis]].


==Treatment==
==Treatment==
===Medical Therapy===


===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]].
Management of this disorder focuses on restoring joint movement and reducing shoulder pain. Usually, it begins with [[nonsteroidal anti-inflammatory drug]]s (NSAIDs) and the application of heat, followed by gentle stretching exercises. These stretching exercises, which may be performed in the home with the help of a physical, massage or [[occupational therapist]], are the treatment of choice. In some cases, transcutaneous electrical nerve stimulation (TENS) with a small battery-operated unit may be used to reduce pain by blocking [[nerve impulse]]s. The next step often involves one or a series of steroid injections (up to six).  
*Stage 2 treatment are given with [[Non-steroidal anti-inflammatory drug|NSAIDs]], [[physical therapy]], [[intra-articular injection]] with steroid.
 
===Surgery===


If these measures are unsuccessful, the doctor may recommend [[Joint manipulation|manipulation]] of the shoulder under general anesthesia to break up the adhesions. [[Surgery]] to cut the adhesions is only necessary in some cases.
*Stage 3 [[treatment]] are given with [[exercise]] with aggressive [[Stretching|stretchin]]<nowiki/>g, [[local anesthesia]] manipulation, [[capsulotomy]] in surgical release.
===Prevention===


[[Alternative medicine]] treatments include:
*There are no [[Primary prevention|primary preventive]] measures available for [[Adhesive capsulitis of shoulder (Patient information)|adhesive capsulitis]].
* Accupuncture for pain
*[[Secondary prevention]] can be taken as following:
* Holistic procedures such as the [[Bowen Technique]]
**Early [[treatment]] and maintenance of chronic illness like [[diabetes mellitus]], [[SLE]], [[Rheumatoid arthritis|RA]].
===Primary Prevention===
**Daily exposure of [[Physical exercise|exercise]] with [[shoulder]], [[neck]], [[back]] [[muscle]], [[tendon]] [[stretching]].
To prevent the problem, a common recommendation is to keep the [[shoulder]] [[joint]] fully moving to prevent a frozen shoulder. Often a shoulder will hurt when it begins to freeze. Because pain discourages movement, further development of [[Adhesion (medicine)|adhesions]] that restrict movement will occur unless the joint continues to move full range in all [[Anatomical position|directions (adduction, abduction, flexion, rotation, and extension)]]. Therapy will help one continue movement to discourage freezing and warm it. A [[medical doctor]] referral is needed before [[occupational therapy|occupational]] or [[physical therapy]] can begin under law in most US states.  Medical referral is not required for physical or occupational therapy in most Canadian provinces.
**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 [[Range of motion|ROM]] exercise postoperatively.


==Related Chapters==
==Related Chapters==
* [[Calcific Tendonitis]]
 
*[[Calcific Tendonitis]]


==References==
==References==
{{reflist|2}}
{{reflist|2}}


==External Links==
*[http://www.aafp.org/afp/990401ap/1843.html "Adhesive Capsulitis: A Sticky Issue"] from [[American Family Physician]], 1999
{{Diseases of the musculoskeletal system and connective tissue}}
[[hr:Ukrućeno rame]]
[[nl:Frozen shoulder]]
[[sv:Adhesiv kapsulit]]
[[zh:沾黏性肩關節囊炎]]


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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]

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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

Classification

Pathophysiology

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:

Differentiating Adhesive capsulitis from other Diseases

For further information about the differential diagnosis, click here.

Epidemiology and Demographics

Age

Gender

Race

  • People from African American and Hispanic or Latino race are more likely to have association with Adhesive capsulitis.[17]

Risk Factors

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]:

Symptoms

  • 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

Laboratory 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

Treatment

Medical Therapy

Surgery

Prevention

Related Chapters

References

  1. ↑ 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. ↑ 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. ↑ 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. ↑ 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. ↑ 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. ↑ 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.
  7. ↑ 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. ↑ 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.
  9. ↑ 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.
  10. ↑ 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.
  11. ↑ 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.
  12. ↑ 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.
  13. ↑ 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.
  14. ↑ "Adhesive Capsulitis - StatPearls - NCBI Bookshelf".
  15. ↑ 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.
  16. ↑ 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.
  17. ↑ 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. ↑ 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.
  19. ↑ "www.orthopt.org" (PDF).
  20. ↑ 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. ↑ 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.
  22. ↑ 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.


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