Show Menu

Adhesive capsulitis Cheat Sheet (DRAFT) by

Presentation, management, etc

This is a draft cheat sheet. It is a work in progress and is not finished yet.


Primary: No identi­fiable causes
Secondary: More common, period of restricted shoulder motion (rotator cuff pathology, trauma, surgery)
Can be caused by thyroid problems and diabetes (both types) - usually associated with poorer clinical outcome and recovery
- Female 55 years of age, non-do­minant side


Stage 1: Achiness, sharpness at end range
Stage 2: painfu­l/f­reezing gradual, progre­ssive loss of shoulder ROM lasting weeks to months
Stage 3: frozen, pain and signif­icant loss of ROM for 12-24 months
Stage 4: thawing stage , progre­ssive decrease in pain and stiffness can last up to 9 months


- Progre­ssive pain either after an event (secon­dary) or came on suddenly (primary)
- Pain focal to the deltoid with sharpness at end range
- Night pain and sleep distur­bances
- Difficulty with overhead movements , behind the back or to the side
- Loss of shoulder ROM (passive and active) in two or more planes of motion in the following order( external, abduction, internal rotation, forward flexion)
- Atrophy of shoulder muscles may be present with no weakness
- Look for scapula dyskinesis and shoulder hitching, upper crossed
- CX spine restri­ctions can be found
- Neurol­ogical exam unrema­rkable
- Secondary AC can mimic rotator cuff pathology (+ve Hawkins Kennedy, Neers, Jobes, Speeds)


- Only to rule out other pathol­ogies (OA/di­slo­cation)
- MRI to rule out Rotator cuff pathology/ no improv­ement with conser­vative care
- MRI can show axillary recess thickening , joint volume reduction, rotator cuff interval thicke­ning, synovitis
- Arthro­scopy


- Inflam­mation in the joint capsule and synovial fluid
- Reactive fibrosis and adhesions of the synovial lining of the joint
- Athroscopy showing a normal shoulder (L) and subacr­omial fibrosis, prolif­erative synovitis and capsular thickening (R)


- F#
- Infection
- Neoplasm
- Calcific tendinitis
- Bursitis
- CX radioc­ulo­pathy
- Fibrom­yalgia
- Shoulder imping­ement
- Rotator cuff pathology
- OA
- systemic arthro­pathy
- Sprain­/strain
- Referred sclera­tog­enous (cardi­ac/­dig­estive )


- Active and passive stretching of shoulder capsule
- Scapula mobili­sation
- CX and TX SMT
- Passive shoulder exercises (cane and Torbay exercises)
- Upper postural correc­tion( upper crossed, scapula dysken­isis)
- Heat/ice
- Explain to patient that this recovery is a slow process and self limiting (most get better suddenly within 18-30 months)
- Spencer technique
- NSAIDs & Cortic­ost­eroids
- Referral to orthop­aedic surgeon if:
- Symptoms are not improving within 10-12 months with conser­vative care
- Steroids/ NSAIDs do not help
- No response to GH/SA injections
- Surgery contra­ind­ica­tions:
- Inadequate course of steroi­ds/­NSAIDs
- Patient has not undergone conser­vative care
- Acute infection
- Concom­itant malignancy in the shoulder
- Neurol­ogical defici­t/nerve complaint from the cx