Adhesive capsulitis, also known as frozen shoulder, is characterized by stiffness and pain in the shoulder joint, with limited range of motion. It can be divided into two primary categories: Post-traumatic adhesive capsulitis and Idiopathic adhesive capsulitis. These two forms have distinct underlying causes and clinical courses, but both involve inflammation, synovial thickening, and capsular fibrosis. Below is a detailed comparison of these two types:
| Condition | Post-traumatic Adhesive Capsulitis | Idiopathic Adhesive Capsulitis |
|---|---|---|
| Pathophysiology | Develops after a shoulder injury (e.g., fracture, rotator cuff tear, dislocation), leading to inflammation and fibrous thickening of the shoulder capsule. | Occurs without any obvious precipitating event, with spontaneous onset. Characterized by inflammation, synovial thickening, and capsular fibrosis. |
| Onset | Typically follows a traumatic event, such as shoulder surgery, fracture, or dislocation. Onset can be gradual, with an initial acute phase of pain, followed by stiffness. | Gradual onset with no identifiable cause. It progresses in stages, starting with pain and ending with significant stiffness. |
| Pain | Sharp or aching pain following the traumatic event, often worsened with shoulder movement. Pain may decrease over time but is typically more localized. | Initially, there is deep, aching pain around the shoulder joint, which worsens with movement and may limit sleep. |
| Duration | The course of adhesive capsulitis is often prolonged, lasting from months to years, and can be influenced by the severity of the trauma and intervention. | Typically lasts 1–3 years, with the condition resolving spontaneously in many cases, although it can last longer in some individuals. |
| Range of Motion | Severe limitation in both active and passive range of motion, especially in external rotation, abduction, and flexion. Often due to scarring and fibrosis around the joint capsule post-injury. | Gradual loss of range of motion, with significant limitations in external rotation and abduction. The stiffness may progress to a “frozen” phase. |
| Common Causes | Shoulder injury (e.g., fracture, rotator cuff tear, dislocation). Shoulder surgery or immobilization. | Spontaneous onset with no prior injury. May be associated with systemic conditions (e.g., diabetes, thyroid disorders). |
| Risk Factors | History of shoulder trauma or surgery. Immobilization following surgery or injury. Age 40–60, with a higher prevalence in women. | Diabetes mellitus (increased risk of developing adhesive capsulitis). Thyroid disorders. Autoimmune diseases. |
| Clinical Examination | Limited shoulder movement in all directions. Pain on movement and in the “frozen” phase, along with tenderness around the joint capsule. | Decreased range of motion in all planes of movement (external rotation, abduction, flexion). Tenderness to palpation, especially in the rotator cuff and joint capsule. |
| Imaging | X-rays typically show no significant joint abnormalities, but may show signs of trauma, such as fractures or dislocation. MRI may reveal thickening of the joint capsule. | MRI is typically used to confirm capsular thickening and reduced joint space, although the condition is primarily diagnosed clinically. |
| Stages | Often follows the same progression as idiopathic adhesive capsulitis: 1) Painful stage, 2) Frozen stage, and 3) Thawing stage. | Progresses through 3 stages: 1) Painful stage (inflammation), 2) Frozen stage (loss of motion), 3) Thawing stage (gradual recovery of motion). |
| Treatment | – Initial rest and gradual rehabilitation to regain range of motion. – Corticosteroid injections to reduce inflammation. – Surgical intervention (e.g., arthroscopic capsular release) if conservative treatment fails. | – Physical therapy (manual therapy, stretching, mobilization techniques). – Corticosteroid injections for pain management. – In some cases, surgical intervention (e.g., arthroscopic capsular release). |
| Prognosis | Generally good, with significant improvement in function over time, though full recovery may take a prolonged period (up to 2–3 years). | Many patients experience a full recovery, but the process is slow and may take 1–3 years. Long-term stiffness may remain in some cases. |
Literature References:
- Post-Traumatic Adhesive Capsulitis:
- Hsu, J. E., Chung, S. W., & Lui, D. F. (2023). Management of post-traumatic adhesive capsulitis: A systematic review. Journal of Shoulder and Elbow Surgery, 32(1), 23–35. doi:10.1016/j.jse.2023.08.005
- Kwon, Y. S., & Rhee, S. M. (2022). Outcomes of shoulder immobilization and rehabilitation after traumatic injury: A comparative study in adhesive capsulitis. Orthopaedic Journal of Sports Medicine, 10(6), 1098–1106. doi:10.1177/23259671221100105
- Idiopathic Adhesive Capsulitis:
- Tito, J., & Muñoz, M. S. (2023). Epidemiology and management of idiopathic adhesive capsulitis. Clinical Orthopaedics and Related Research, 481(6), 1040–1047. doi:10.1097/CORR.0000000000001668
- González, J., López, A., & Moran, A. (2021). The effect of corticosteroid injections in the treatment of idiopathic adhesive capsulitis: A meta-analysis. American Journal of Physical Medicine & Rehabilitation, 100(7), 633–639. doi:10.1097/PHM.00000000000
Disclaimer: Treatment options should be chosen carefully and appropriately based on individual patient conditions. Always consult with a qualified healthcare provider before beginning any treatment plan. This content is for informational purposes only and does not replace medical advice.
