Review: Attention to detail necessary in diagnosis, treatment of adhesive capsulitis

A literature review published in the Journal of the American Academy of Orthopaedic Surgeons claims a diagnosis of adhesive capsulitis is “vague,” noting there are many factors that contribute to motion loss in the shoulder.

The review, co-authored by Robert J. Neviaser, MD, noted that various other shoulder pathologies can demonstrate similar clinical symptoms, and thus, these diagnoses must be kept in mind — as proper management of symptoms depends heavily upon the identification of the correct etiology.

These identifications can be made, the Neviaser and colleagues wrote, through the identification of “subtle clues” in physical examination and the patient’s history.

Diagnosing adhesive capsulitis

According to the review, the most common adhesive capsulitis symptoms include night pain; an inability to sleep on the affected side; a restriction of movement that gives patients difficulty dressing, combing their hair or reaching into their back pocket; and a lack of pain when the shoulder motion grows restrictive. Sudden movement beyond the limits of stiffness, however, will cause pain.

“As a result of an inflammatory process, the joint lining develops scarring which becomes a restraint to movement — like a tether,” Neviaser stated in an American Academy of Orthopaedic Surgeons release. “Within the limits of what that restraint or tether allows, the person is usually uncomfortable, but they can function. If they suddenly reach beyond that, without thinking … then they develop a sharp, severe pain, because what they’re doing, effectively, is microscopic tearing of the scar tissue.”

Neviaser noted in the release that shoulder joint arthritis can resemble adhesive capsulitis during physical examination — but shoulder joint arthritis comes with a “ratchety, grinding sensation” that does not manifest during adhesive capsulitis. Furthermore, an X-ray would indicate any arthritic changes.

Managing pain, restoring movement

In the review, Neviaser recommended gentle, progressive stretching exercises during the course of several weeks or even months to restore range of movement and reduce discomfort.

“The first step in treatment is a physical therapy program to stretch the capsule slowly and progressively,” he stated in the release. “We limit surgical interventions to patients who do not show adequate progress over a period of months of physical therapy, and are still significantly restricted in their movement and function in daily life.”

Neviaser added that if surgery is needed, arthroscopic capsular release has shown improved pain relief and restoration of shoulder function 2 years to 5 years postoperatively.

Reference:

Neviaser AS, Neviaser RJ. Adhesive capsulitis of the shoulder. J Am Acad Orthop Surg. 2011. Sep;19(9):536-542.

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