Figure 1: Anteroposterior radiograph of left shoulder.
Figure 2. Axillary view of shoulder.
A 56-year-old man presents with a 4-month history of left shoulder pain and stiffness. The patient does not know how he injured the shoulder and has tried oral nonsteroidal anti-inflammatory drugs (NSAIDs) and physical therapy over the last few months with no relief. On physical examination, the patient has significantly limited left shoulder active and passive range of motion (ROM) in all planes but full right shoulder active and passive ROM. The patient is a type 2 diabetic that is controlled by diet. Radiographs are ordered (Figures 1 and 2).
Submit your diagnosis to see full explanation.
Adhesive capsulitis, or frozen shoulder, is characterized by functional loss of both passive and active shoulder ROM because of fibroblastic proliferation within the joint capsule.1 Adhesive capsulitis most commonly occurs in middle-aged women and has a high association with hypothyroidism, diabetes, and previous cervical spine surgery.1 Most cases will resolve with conservative treatment within 6 months.1
The key to treatment is continued shoulder motion with physical therapy and a home stretching program. The focus of therapy should be on a gentle and progressive stretching program. An intra-articular corticosteroid injection has been shown to improve passive motion and shorten the overall duration of symptoms.2
The presence of functional deficits after more than 6 months of physical therapy warrants discussion about surgical options, which may include a manipulation under anesthesia or an arthroscopic capsular release.1 Sling immobilization is contraindicated because it likely will promote further joint contracture and prolonged recovery.1,2
Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor in chief of the Journal of Orthopedics for Physician Assistants.
1. Redler LH, Dennis ER. Treatment of adhesive capsulitis of the shoulder. J Am Acad Orthop Surg. 2019;27(12):e544-e554. doi:10.5435/JAAOS-D-17-00606
2. Wang W, Shi M, Zhou C, et al. Effectiveness of corticosteroid injections in adhesive capsulitis of shoulder: a meta-analysis. Medicine (Baltimore). 2017;96(28)e7529. doi:10.1097/MD.0000000000007529