EpistemisAdhesive capsulitis of the shoulder
Specialty: Musculoskeletal.
Why it occurs
- Idiopathic (fibrosis and thickening of the joint capsule and coracohumeral ligament)
- Diabetes mellitus type 1 and 2 (strong association, more torpid and bilateral evolution)
- Prolonged immobilization of the shoulder (sequence of fracture of the clavicle, humerus or thoracic/breast surgery)
- Uncontrolled hypothyroidism or hyperthyroidism
- Parkinson's disease or previous stroke
- Chronic rotator cuff tendinopathy not rehabilitated
Initial workup
Physical examination (severe loss of active and passive range of motion of the shoulder in all planes, especially external rotation) | MRI of the shoulder (reveals thickening of the coracohumeral ligament > 4 mm and obliteration of the axillary recess) | AP shoulder x-ray (rule out severe glenohumeral osteoarthritis and massive calcifications).
red flags
Intolerable nocturnal shoulder pain that does not subside with powerful analgesics, unexplained accelerated weight loss, hard palpable axillary or supraclavicular lymphadenopathy, or visible mass in the shoulder (suggests primary malignant tumor or bone metastasis in the humeral head).
Standard management
- Ibuprofen — 600 mg every 8 hours orally in the initial hyperalgic phase
- Ultrasound-guided intra-articular infiltration of triamcinolone acetonide — 40 mg with lidocaine; highly effective in breaking the inflammatory cycle in phase 1
- Capsular hydrodilation (intra-articular injection of sterile saline volume with corticosteroids under ultrasound or fluoroscopic control to distend the retracted capsule).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Musculoskeletal
- Listed causes
- 6
- Treatment options
- 3