Summary Adhesive capsulitis (also known as frozen shoulder) is a condition of the shoulder characterized by functional loss of both passive and active shoulder motion commonly associated with diabetes, and thyroid disease. Diagnosis is made clinically with marked reduction of both active and passive range of motion of the shoulder. Treatment is a prolonged course of aggressive physical therapy and medical management of underlying disease if present (i.e diabetes, thyroid disorder). Manipulation under anesthesia or arthroscopic capsular release is indicated in patients with progressive loss of motion having failed a prolonged course of physical therapy. Epidemiology Demographics more common among women ages 40-60 years login to view 1 more bullet Etiology Pathophysiology mechanism of injury login to view 3 more bullets pathoanatomy login to view 4 more bullets Associated conditions diabetes (both types) login to view 4 more bullets thyroid disorders (autoimmune etiology) dupuytren's disease atherosclerotic disease cervical disc disease Anatomy Capsuloligamentous structures function login to view 2 more bullets glenohumeral ligaments login to view 6 more bullets Rotator interval a triangular region between the anterior border of supraspinatus and the superior border of subscapularis contains the SGHL and coracohumeral ligament Classification Clinical Stages Freezing/Painful Gradual onset of diffuse pain (6 wks to 9 months) Frozen/Stiff Decreased ROM affecting activities of daily living (4 to 9 months or more) Thawing Gradual return of motion (5 to 26 months) Arthroscopic Stages Stage 1 Patchy, fibrinous synovitis Stage 2 Capsular contraction and fibrinous adhesions Stage 3 Increasing contraction, synovitis resolving Stage 4 Severe contraction Presentation Symptoms common symptoms login to view 5 more bullets Physical exam inspection login to view 1 more bullet motion login to view 5 more bullets provocative tests login to view 2 more bullets Studies Metabolic panel and endocrine labs (TSH, A1c) Imaging Radiographs recommended views login to view 3 more bullets alternate views login to view 1 more bullet findings login to view 2 more bullets MRI +/- arthrography indications login to view 1 more bullet findings login to view 2 more bullets Treatment Nonoperative physical therapy, NSAIDs and/or intra-articular steroid injections, heat and/or cryotherapy login to view 4 more bullets distension arthrography login to view 1 more bullet Operative manipulation under anesthesia (MUA) login to view 6 more bullets arthroscopic or open capsular release login to view 3 more bullets Techniques Physical therapy daily progressive stretching exercises to point of pain supervised or home-based programs successful for overwhelming majority Manipulation under anesthesia assess and document pre-procedure range of motion anesthesia login to view 2 more bullets manipulation login to view 1 more bullet postoperative login to view 1 more bullet complications login to view 2 more bullets Arthroscopic capsular release assess and document pre-procedure range of motion anesthesia login to view 1 more bullet approach login to view 1 more bullet release login to view 5 more bullets manipulation login to view 1 more bullet postoperative login to view 1 more bullet Complications Residual stiffness Axillary nerve injury with capsular release perform inferior release near to glenoid rim Proximal humerus fracture, dislocation, rotator cuff tears or brachial plexopathy following overzealous manipulation with osteoporotic bone Prognosis Self-limited disease Worse outcomes among diabetics After surgical treatment, gains in range of motion and improved function are maintained at long-term follow