Adhesive capsulitis

Abstract

Adhesive capsulitis (CA; also called Frozen shoulder) is acommon, usually unilateral disease of the shoulder joint primarily affecting middle-aged women. Primary, idiopathic, and secondary forms are distinguished. Painful active and passive movement restriction are the clinically leading symptoms. The disease usually progresses in three successive stages: freezing phase, frozen phase, and thawing phase. CA is primarily diagnosed clinically, with imaging being used to assess or exclude differential diagnoses. Radiography as part of basic diagnostics allows exclusion of common differential diagnoses such as osteoarthritis of the shoulder or calcific tendinitis. Native magnetic resonance imaging (MRI) and MR arthrography (MRA) reveal pathomorphologies typical of CA. Intravenously administered gadolinium increases the sensitivity of MRI. Sonography may be used as acomplementary diagnostic modality or as an alternative in case of contraindications to MRI. Fluoroscopy-guided arthrography has been replaced by MRI because of its invasiveness. Computed tomography (CT) has no role in diagnostics due to its radiation exposure and significantly lower sensitivity and specificity compared to MRI. Therapy of CA is stage-adapted and includes conservative measures such as analgesics and physiotherapy and surgical procedures such as arthroscopic arthrolysis. The therapeutic spectrum is supplemented by new, innovative procedures such as transarterial periarticular embolization. CA is self-limiting and usually persists for 2-3years. However, the patients may even suffer from pain and limited range of motion beyond this time.