Title : Frozen shoulder (adhesive capsulitis)
Abstract:
Frozen shoulder, or adhesive capsulitis, is a condition characterized by gradual, painful restriction of both active and passive shoulder motion with normal radiographic findings except possible osteopenia. This presentation covers the anatomy of the shoulder, biomechanics of shoulder movement (flexion, extension, abduction, adduction, medial/lateral rotation), and the historical evolution of the condition from Duplay (1872) to Neviaser (1945). Epidemiology shows a female predominance (F:M = 10:8), a general population incidence of 2–5%, and a much higher incidence of 10–35% in diabetic patients. Mean age ranges from 40–60 years, with bilateral involvement in 20–30% of cases. Etiology is classified as primary (idiopathic) or secondary (systemic: diabetes, thyroid disorders, autoimmune conditions; intrinsic: rotator cuff tears, calcific tendinitis; extrinsic: fracture residuals, CVA, head injury, myocardial infarction). The condition progresses through three stages: freezing (painful, 2–9 months), frozen (stiffness, 4–12 months), and thawing (resolution, 6–12 months).
Pathology begins with synovitis leading to capsular fibrosis and thickening. Diagnosis is clinical, based on progressive pain, night pain, difficulty with ADLs (tucking shirts, fastening bra, reaching back pocket), and physical examination showing marked restriction of external rotation, abduction, and limited flexion/internal rotation. X-ray is normal by definition; MRI may show capsular thickening; arthroscopy reveals a tight, contracted joint space. Management includes physiotherapy (ultrasound, pendulum, shoulder wheel, pulley exercises), NSAIDs, corticosteroid injections, strict diabetic control, and manipulation under anesthesia (70% response). Surgery (arthroscopic capsular release) is indicated for non-responders, followed by immediate physiotherapy. Complications include persistent stiffness, functional loss, and rare neurovascular injury. While the condition is self-limiting over 1–3 years, structured physiotherapy accelerates recovery and restores shoulder function.
