Adhesive Capsulitis: A Comprehensive Review of Pathogenesis, Diagnosis, and Clinical Management

Adhesive capsulitis (AC) is a condition characterized by progressive pain and restricted range of motion, which may significantly impact patients' quality of life. It affects 2-5% of the population, with a higher prevalence in women, individuals with diabetes, and other underlying conditions. The pathogenesis involves synovial inflammation, capsular fibrosis, and neovascularization, although the initiating factors remain unclear. AC progresses through distinct phases: freezing, frozen, and thawing: each with characteristic clinical and pathological features.

This review article synthesizes findings from peer-reviewed studies on adhesive capsulitis, focusing on pathophysiology, clinical presentation, and treatment outcomes. A comprehensive literature search was conducted, selecting studies based on relevance, study design, and emphasis on randomized controlled trials, systematic reviews, and meta-analyses.

Management options include both conservative and surgical approaches. Conservative treatment focuses on physical therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroid injections, and manipulation under anesthesia, with most patients experiencing resolution over time. Other interventions, such as ultrasound-guided hydrodilatation and arthroscopic release, may be indicated for recalcitrant cases, typically in patients with continued symptoms lasting longer than 9-12 months. Hydrodilatation, particularly capsule-preserving techniques, has shown promise in reducing pain and improving function. Arthroscopic release provides rapid pain relief and improved ROM, with long-term success demonstrated in clinical studies, though recurrence of postoperative pain may necessitate corticosteroid injections.

Further research is needed to better understand the etiology and pathogenesis of AC, as well as to develop more effective, stage-based, and disease-modifying treatments. This approach may offer insights into targeted therapies and improved recovery in patients with AC.

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