13/07/2025
Just published 🔥
Infographic: Adhesive Capsulitis of the Shoulder
📘https://www.arthroscopyjournal.org/article/S0749-8063(25)00224-5/fulltext
▶️ Definition: Adhesive capsulitis is characterized by limited range of motion (ROM, https://pubmed.ncbi.nlm.nih.gov/30811157/) , as well as associated signs and symptoms including sleep disturbance, anxiety, and impaired functions that may impose a serious burden on patients’ activities of daily living (https://pubmed.ncbi.nlm.nih.gov/24078753/).
🔬 Pathophysiology: An inflammatory reaction progresses to fibrotic contracture, with active fibroblastic proliferation and collagen formation resulting in a stiff and thickened glenohumeral capsule with abundance of type III collagen. (https://pubmed.ncbi.nlm.nih.gov/33205235/)
🥶 Clinical Phases: The condition is classified into freezing, frozen, and thawing phases. However, owing to considerable overlap between stages, there is highly variable reference to the distinct stages in the literature presented, and its use in guidelines for treatment decision-making is limited (https://pubmed.ncbi.nlm.nih.gov/40291049/).
⚠️ Risk Factors: Diabetes, hyperthyroidism, prior fractures, shoulder or cervical spine surgery, and radiation therapy increase risk (https://www.ncbi.nlm.nih.gov/books/NBK532955/).
👩 Prevalence: Affects 2–5% of individuals, with higher rates in women. (https://pubmed.ncbi.nlm.nih.gov/21167743/)
🩺 Diagnosis: Plain radiographs are often unremarkable; Normal X-rays in two planes may be used to rule out mechanical glenohumeral incongruity such as arthritis, avascular necrosis or tumor, which might produce a similar clinical picture (https://pmc.ncbi.nlm.nih.gov/articles/PMC12018368/). MRI may show thickened capsule, synovial hypertrophy, and joint capsule edema.
💪 Nonsurgical Treatment: Focuses on pain relief and restoring ROM via physical therapy, oral anti-inflammatories, corticosteroid injections, extracorporeal shock wave therapy, and ultrasound-guided hydrodistention. (https://pubmed.ncbi.nlm.nih.gov/33292924/)
💉 Corticosteroid Injections: Early injections shorten symptom duration; rotator interval approach (https://pubmed.ncbi.nlm.nih.gov/29268022/) and lower doses (20 mg, https://pubmed.ncbi.nlm.nih.gov/37774178/) may yield better outcomes.
🌊 Hydrodilatation: Ultrasound-guided hydrodilatation with hyaluronic acid plus physical therapy shows superior results compared to physical therapy alone up to 12 weeks follow-up. (https://pubmed.ncbi.nlm.nih.gov/37697666/)
⚡️Diabetes Patients: Extracorporeal shock wave therapy avoids metabolic complications from steroids. (https://pubmed.ncbi.nlm.nih.gov/27899492/)
📊 Self-Limiting: Most patients achieve symptom improvement without surgery. But: The long-held theory of recovery phases leading to complete resolution without treatment for frozen shoulder is unfounded (https://pubmed.ncbi.nlm.nih.gov/30952550/).
🔧 Surgical Options: Considered after 9–12 months of failed nonsurgical management, including arthroscopic capsular release, manipulation under anesthesia (MUA), or both. (https://pmc.ncbi.nlm.nih.gov/articles/PMC11216839/)
👀 MUA vs. Arthroscopy: MUA is more cost-effective (https://pubmed.ncbi.nlm.nih.gov/36048234/) and arthroscopy had a higher risk of complications and adverse events during short term follow-up (https://pmc.ncbi.nlm.nih.gov/articles/PMC11216839/).
