Adhesive Capsulitis
What is it: Adhesive capsulitis is a condition that causes capsular tightening about the shoulder resulting in pain and progressive loss of range of motion.
How does it present: Patients often complain of a painful shoulder and worsening ability to move the shoulder. As the pain increases, patients tend to move the shoulder less, thus worsening the stiffness of the shoulder. It can often be confused with rotator cuff injuries. Although the condition can be related to trauma, often there is no inciting injury and etiology is unknown. There is an increased incidence on diabetics.
Common exam findings: On exam the patient will often have pain with active and passive range of motion in abduction, forward flexion, internal and external rotation. In this way it can be confused with rotator cuff pathology. However, in adhesive capsulitis there should be an endpoint with passive range of motion. Note: This endpoint can be difficult to differentiate from an endpoint related to the patient’s level of pain. To further evaluate, do a subacromial lidocaine injection and then check passive range of motion when the patient’s pain is under better control.
Tests and treatment: X-rays may be considered to rule out other causes. Treatment is usually conservative, i.e., pain management and progressive work on the patient's range of motion. The healing process may extend over a period of several months (or years), and sometimes self-resolve. In resistant cases, manipulation under anesthesia can be considered by orthopedics.