Adhesive capsulitis - pathophysiology, clinical presentation, imaging, treatment, complication

Adhesive capsulitis, commonly known as "frozen shoulder," is a condition characterized by stiffness and pain in the shoulder joint. Over time, the shoulder becomes very hard to move. This condition typically occurs in three stages:
1. **Freezing Stage**: In this initial phase, any movement of the shoulder causes pain, and the range of motion starts to become limited. This stage can last from six weeks to nine months.
2. **Frozen Stage**: During this stage, the pain may begin to diminish, but the shoulder becomes stiffer, and it becomes more challenging to use. This stage can last from four to twelve months.
3. **Thawing Stage**: In the final stage, the range of motion in the shoulder begins to improve. This phase can last from six months to two years.
Causes and Risk Factors
The exact cause of adhesive capsulitis is not well understood, but several factors can increase the risk of developing the condition, including:
- **Age and Sex**: People between the ages of 40 and 60, especially women, are more likely to develop frozen shoulder.
- **Medical Conditions**: Certain medical conditions, such as diabetes, hypothyroidism, hyperthyroidism, Parkinson’s disease, and cardiac disease, can increase the risk.
- **Immobilization**: Prolonged immobilization of the shoulder, often due to surgery, fracture, or other injury, can lead to the development of adhesive capsulitis.
Symptoms
The primary symptoms of adhesive capsulitis include:
- Pain in the outer shoulder area and sometimes the upper arm.
- Stiffness and restricted range of motion.
- Difficulty performing everyday activities like dressing, reaching for objects, or even sleeping on the affected side.
Diagnosis
Diagnosis is primarily based on the patient’s medical history and a physical examination. A doctor may assess the range of motion and may also order imaging tests like X-rays or MRI to rule out other conditions.
Treatment
Treatment for adhesive capsulitis focuses on relieving pain and restoring movement. Options include:
- **Medications**: Over-the-counter pain relievers such as ibuprofen or acetaminophen.
- **Physical Therapy**: Exercises to improve the range of motion.
- **Heat Therapy**: Application of heat to the affected area to reduce pain and stiffness.
- **Steroid Injections**: Corticosteroid injections to reduce inflammation and pain.
- **Hydrodilatation**: Injection of sterile fluid into the joint to expand the capsule and improve movement.
- **Surgery**: In severe cases, surgical options such as manipulation under anesthesia or arthroscopic surgery may be considered.
Prognosis
With appropriate treatment, most people with adhesive capsulitis recover within one to three years. However, some individuals may experience lingering stiffness and discomfort.
Managing and preventing adhesive capsulitis involves staying active, performing regular shoulder exercises, and avoiding prolonged shoulder immobilization. If you suspect you have symptoms of frozen shoulder, it is important to consult with a healthcare professional for an accurate diagnosis and appropriate treatment plan.