![]() 12 Shoulder girdle tumors, although rare, may also mimic the symptoms of frozen shoulder. Some have speculated, however, that adhesive capsulitis is in-fact a type of “sympathetic dystrophy,” based on decreases in bone mineral density seen in patients with frozen shoulder. For example, chronic regional pain syndrome (CRPS, formerly known as reflex sympathetic dystrophy) may cause severe limitations in shoulder range of motion similar to those seen with a frozen shoulder however, CRPS is also associated with swelling and other trophic skin changes in the extremity. 11įrozen shoulder may also be confused with other clinical syndromes therefore, it is important to have an accurate differential diagnosis to rule out other pathologies. 4 Frozen shoulder is also a common complication following stroke, occurring in 25% of patients within 6 months. 9 Both Type I and Type II diabetics are susceptible to frozen shoulder 10 unfortunately, diabetics have worse functional outcomes as measured by disability and quality of life questionnaires compared to non-diabetics with frozen shoulder. 2 In a 1986 study, 19% of older diabetic patients had adhesive capsulitis 8 however, recent estimates place the incidence as high as 71% when patients with pre-diabetes (metabolic syndrome) are included. 7 In a profile study of 32 patients with adhesive capsulitis, heart disease and diabetes were more prevalent in those suffering from adhesive capsulitis than a control group. 6 Secondary adhesive ¬capsulitis occurs after a shoulder injury or surgery, or may be associated with another condition such as diabetes, rotator cuff injury, cerebrovascular accident (CVA) or cardiovascular disease, which may prolong recovery and limit outcomes. Primary adhesive capsulitis results from a chronic inflammatory response with fibroblastic proliferation, which may actually be an abnormal response from the immune system. Idiopathic (“primary”) adhesive capsulitis occurs spontaneously without a specific precipitating event. Although the exact pathophysiologic cause of this pathology remains elusive, there are two types identified in the literature: idiopathic and secondary adhesive capsulitis. Approximately 70% of frozen shoulder patients are women 3 however, males with frozen shoulder are at greater risk for longer recovery and greater disability 3– 4. 2 The most common limitations in range of motion are flexion, abduction, and external rotation. Patients typically describe onset of shoulder pain followed by a loss of motion. 1 He concluded that frozen shoulder was not periarthritis, but a “thickening and contraction of the capsule which becomes adherent to the humeral head” that he termed, “adhesive capsulitis.” 1 Adhesive capsulitis is characterized by pain, stiffness, and limited function of the glenohumeral joint, which adversely affects the entire upper extremity. The “frozen shoulder” diagnosis has been used for many years in describing shoulder pain and limited motion, and was originally thought to be “periarthritis.” Nevasier was the first to identify the pathology through histological and surgical examination of frozen shoulder patients.
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