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Adhesive capsulitis



Adhesive capsulitis, also known as frozen shoulder syndrome, is the thickening and contraction of the glenohumeral capsule that is characterized by pain, stiffness, and limited function of the glenohumeral joint.
The cause of adhesive capsulitis is unknown; however, it is associated with a shoulder injury or surgery, diabetes, rotator cuff injury, cerebrovascular accident, or CVD.
Disease course
The thickening and contraction of the shoulder capsule and inflammatory changes in the shoulder joint capsule result in adhesive capsulitis, which causes clinical manifestations of pain, stiffness, decrease in the ROM (with flexion, abduction, external and internal rotation) of the affected shoulder. The disease progresses through three phases, namely, painful, stiffness, and recovery or thawing stage.
Prognosis and risk of recurrence
Adhesive capsulitis is not associated with an increase in mortality.


Key sources

The following summarized guidelines for the evaluation and management of adhesive capsulitis are prepared by our editorial team based on guidelines from the American Academy of Family Physicians (AAFP 2019), the American College of Radiology (ACR 2018), and the American Physical Therapy Association (APTA 2013)....
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Screening and diagnosis

Differential diagnosis: as per APTA 2013 guidelines, Consider assessing for alternative diagnoses if the reported activity limitations or impairments of body function and structure are not consistent with the diagnosis/clinical presentation of adhesive capsulitis, or if the patient's symptoms do not respond to treatment.
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  • Clinical presentation

Diagnostic investigations

Physical examination: as per APTA 2013 guidelines, Assess for impairments in the capsuloligamentous complex and musculotendinous structures surrounding the shoulder complex when a patient presents with shoulder pain and mobility deficits. Elicit loss of passive motion in multiple planes, particularly external rotation with the arm at the side and in varying degrees of shoulder abduction, which is a significant finding that can be used to guide treatment planning.
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  • Functional assessment tools

  • Diagnostic imaging

  • Evaluation for comorbidities

Nonpharmacologic interventions

Stretching exercises: as per APTA 2013 guidelines, Instruct patients with adhesive capsulitis to perform stretching exercises, and guide the intensity of the exercises by the patient's tissue irritability level.

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  • Joint mobilization

Therapeutic procedures

Intra-articular corticosteroid injections
As per AAFP 2019 guidelines:
Consider combining corticosteroid injections with physiotherapy for greater symptom improvement.
Consider combining corticosteroid injections with hydrodilatation for expedite recovery of pain-free ROM.

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  • Translational manipulation

  • Electrotherapy

Patient education

Patient education: as per APTA 2013 guidelines, Educate patients about the natural course of the disease, promote activity modification to encourage functional, pain-free ROM, and ensure that the intensity of stretching matches to the patient's current level of irritability.