Adhesive Capsulitis

Adhesive Capsulitis

Significant restriction of both active & passive shoulder ROM
Risk factors: diabetes, hypothyroidism, hyperthyroidism & hypoadrenalism

Signs & Symptoms:
Insidious onset of gradual loss of function associated with vague discomfort following minimal or no trauma. Usu worse at night but difficulty in performing overhead & behind the back activities. Physical exam reveals increased AROM & PROM with pain at extremes of motion.

Classification: Neer (1983) based on degree of involvement of rotator cuff
Stage I – inflammation & edema of rotator cuff
Stage II – fibrosis & tendonitis
Stage III – partial or full-thickness rotator cuff tear

Careful history & physical to r/o instability, rotator cuff tears, bicipital tendonitis.

Imaging: plain xrays – 3 views
MRI +/- gadolinium, U/S, contrast arthrography

Treatment:
Mainstay = nonoperative
– activity modification
– NSAIDS
– stretching exercises
– strengthening exercise Surgical treatment:
– goals = pain relief & restoration of function
– Stage I or II à arthroscopic subacromial bursectomy & acromioplasty; shoulder arthroscopy
– Stage III à rotator cuff repair in young patients with subacromial bursectomy & acromioplasty
debridement in older paitents if cuff unrepairable