Review Question - QID 4431

Adhesive capsulitis is believed to involve a fibroblastic process and the clinical scenario in response 3 is classic for this condition.

While most cases of adhesive capsulitis are idiopathic, risk factors include: females, age 40-60, and some medical conditions such as diabetes and hypothyroidism. It causes a restricted intra-capsular volume, pain, and global loss of motion. Loss of both active and passive motion helps to identify stiffness rather than weakness.

Bunker et al. examined biopsies of shoulder capsular tissues and described "active fibroblastic proliferation, accompanied by some transformation to a smooth muscle phenotype (myofibroblasts)." They noted that the fibroblasts lay down collagen which is similar in appearance to Dupuytren's disease of the hand, with no inflammation and no synovial involvement.

Illustration A shows an arthroscopic view of a patient with adhesive capsulitis of the shoulder (as seen from the posterior portal with the patient in the beachchair position).

Incorrect Responses:
Answer 1. Polymyalgia rheumatica (PMR) is associated with giant cell (temporal) arteritis and occurs in patients over 50.
Answer 2. Podagra is common in gout which can also affect the shoulder, but it is a crystal deposition disease, not a fibroblastic process.
Answer 4. Ulnar drift is seen with rheumatoid arthritis.
Answer 5. A positive ANA is seen in patients with lupus.