Adhesive Capsulitis of the Shoulder

Area of Science:

• Orthopedics
• Rheumatology
• Sports Medicine

Background:

• Adhesive capsulitis, commonly known as frozen shoulder, involves progressive glenohumeral joint capsule stiffness and pain.
• Pathophysiology includes inflammation, fibroblastic proliferation, and collagen deposition leading to contracture.
• Risk factors encompass diabetes, thyroid disorders, and prior shoulder or spine surgery.

Purpose of the Study:

• To review the pathophysiology, clinical presentation, and management strategies for adhesive capsulitis.
• To compare the efficacy of various nonsurgical and surgical treatment modalities.
• To highlight factors influencing treatment outcomes and patient selection.

Main Methods:

• Literature review of studies on adhesive capsulitis pathophysiology, diagnosis, and treatment.
• Analysis of clinical classifications, diagnostic imaging findings (MRI), and risk factors.
• Evaluation of nonsurgical options (PT, injections, shock wave therapy, hydrodistention) and surgical interventions (arthroscopic release, MUA).

Main Results:

• Nonsurgical treatments aim to relieve pain and restore range of motion (ROM).
• Early corticosteroid injections and ultrasound-guided hydrodilatation with hyaluronic acid show improved outcomes.
• Surgical options like arthroscopic capsular release and manipulation under anesthesia (MUA) are effective for refractory cases.

Conclusions:

• Adhesive capsulitis is often self-limiting, but prompt management can improve outcomes.
• Nonsurgical interventions, particularly early corticosteroid injections and PT, are primary treatments.
• Surgical intervention offers significant improvement in pain and function for persistent cases, with arthroscopy providing direct visualization.