AANA Middle East Arthroscopy Master Course (International)-Adhesive Capsulitis (frozen shoulder)

Adhesive Capsulitis (frozen shoulder)

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Adhesive capsulitis, also known as frozen shoulder, is a condition characterized by stiffness and limited shoulder movement. It commonly affects individuals with diabetes, thyroid disease, or those who have undergone cardiac surgery. There are two main types: idiopathic (unknown cause) and post-injury or post-surgical adhesive capsulitis.<br /><br />Post-operative stiffness occurs in about 5% of shoulder surgeries such as labral repairs, SLAP lesions, and rotator cuff repairs. Early signs include failure to regain normal range of motion, especially loss of external rotation, and persistent pain after surgery that does not improve over time.<br /><br />Diagnosis involves physical examination showing both active and passive motion loss, with early contracture in the rotator interval. Patients may experience impingement-like symptoms due to capsular contracture causing abnormal shoulder translations. X-rays are often more informative than MRI, revealing subacromial spurs or metallic implants.<br /><br />Initial treatment typically includes physical therapy and injections for 3-4 months. However, post-operative stiffness may require earlier arthroscopic capsular release surgery if motion does not improve within 1-2 months. Examination under anesthesia helps identify which capsule structures to release, avoiding blind manipulation which can be harmful.<br /><br />Arthroscopic surgical release targets the rotator interval, middle glenohumeral ligament, anteroinferior and posterior capsules while protecting important structures like the subscapularis tendon. Sometimes, additional procedures such as removing loose bodies, repairing rotator cuff, or acromioplasty revision may be needed.<br /><br />Postoperatively, intensive therapy begins the day after surgery, five days per week for two weeks, with overall recovery lasting 6-9 months. Early, aggressive intervention is critical, and thorough preoperative evaluation under anesthesia is recommended before every rotator cuff surgery to identify pre-existing capsulitis and tailor treatment accordingly. <br /><br />In summary, idiopathic and post-operative adhesive capsulitis require different management strategies, emphasizing selective capsular release based on detailed assessment to optimize patient outcomes.

Keywords

Adhesive capsulitis

Frozen shoulder

Post-operative stiffness

Shoulder surgery complications

Rotator interval contracture

Arthroscopic capsular release

Physical therapy for shoulder

Shoulder range of motion loss

Post-surgical shoulder pain

Capsular contracture diagnosis