Spontaneous Conditions: Adhesive Capsulitis (Frozen Shoulder)

Adhesive capsulitis usually results from trauma which in turn leads to capsular contraction. Clinically there is globally reduced range of movement (ROM), with enhanced scapulo-thoracic movements as the patient can only abduct in this way.

The hands on hip test (Sloans test) is helpful. It should be possible to move the elbows more anterior to the fixed wrists. The pain gets worse with activity, and night pain is always present.

Fig 1: Demonstrates capsule tightness	Fig 2: The hands on hips (Sloan’s) test

Angiogenesis is the early hallmark, which is clearly seen on arthroscopy. As the condition is not inflammatory NSAIDs are of limited value but steroids can limit the angiogenesis. Capsular contraction follows the angiogenesis. Biopsy shows type 3 collagen and the myofibroblastic transformation seen in Dupuytrens is permanent, whilst a frozen shoulder will thaw out.

Judicious physiotherapy can limit capsular tightness, but manipulation under anaesthetic (MUA) produces good results with many patients gaining an almost full ROM in 2-3 months [18].

Learning bite

MUA is an effective management of adhesive capsulitis.