Adhesive Capsulitis has been classified into primary (idiopathic) and secondary types. Primary causes occur spontaneously. Secondary cases commonly develop in response to trauma to the upper extremity, upper exremety immobilisation , abnormal shoulder mechanics. While the defiinitive aetiology of this condition is unknown, adhesive capsulitis has been reported to have associations with other conditions, including cervical spine disease , diabetes mellitus, rheumatoid arthritis, infectious myocardial infarction and pulmonary cancer. Occurs 40-60 yrs of age, Females more prevalent than males, left shoulder more than right. Pathology involves fibrosis and thickening of the glenohumeral capsule. The condition is painful but self limiting with the average duration of symptoms 2.5 years.
On the left of screen is one of the positive tests for “Adhesive Capsulitis-Frozen Shoulder” showing a restriction in external rotation, as well as being painful. On the right of screen is an animation of a thickened capsule, increased vascularity which is accompanied with increased nociceptor “pain” nerve formation.
External rotation is decreased.
Adhesive capsulitis has been reported to have associations with other conditions specifically cervical pain 25%, calcium deposits 10%, diabetes 6%.
Pathology: There is an increased hypervascular synovium, in long term cases there was a significant fibrosis, hyalinzation, and fibrinoid degeneration in the latter phases of the disease in the sub-synovium capsule.
Operative observations of adhesive capsulitis.
1. The capsule, synovial tissue and rotator cuff are thickened, fibrotic, contracted and closely adherent to the humeral head.
2. The coracohumeral ligament and rotator interval are thickened, fibrotic and contracted and the humeral head is held tightly against the glenoid fossa.
3. Inflammatory changes affect the synovium, bursae, rotator cuff and biceps tendon.The long head of biceps becomes stenosed in the bicipital groove.
4. Articular surface changes affect the humeral head and glenoid fossa.
5. Partial and full thickness tears are observed in the rotator cuff.
