Shoulder Capsulitis

Prevalence

• 2 to 5%

• 50s and 60s most common

Cause

• Primary or linked to other diseases

• Diabetes = 3 x more likely

• Lifetime prevalence in T1DM = 76%

Associations

• Thyroid disease

• Dyslipidaemia

• Prolonged immobilisation

• Stroke

• Autoimmune disease

Presentation

• Initial painful phase - Diffuse, severe, worse at night, lasts 2 to 9 months

• Second phase - Stiffness and loss of motion, less pain, lasts 4 to 12 months

• Recovery phase - Return to motion takes 5 to 24 months

Exam

• External rotation and abduction most affected

• Firm, painful, premature end to passive range of motion

Diagnosis

• Clinical

Differential

• Rotator cuff pathology

Management

• Mostly self limiting but complete resolution does not occur in many patients

• Good history

• Imaging as indicated

  • Plain XRAY

  • Ultrasound to exclude rotator cuff

  • If uncertain consider diagnostic corticosteroid injection

• Intra-articular glucocorticoid injection for moderate to severe symptoms

• Next 2 to 3 months

  • Shoulder rest with gentle ROM exercises

  • Review 3 to 4 weekly

  • If no improvement consider intra-articularly corticosteroid

  • If significant improvement then more aggressive exercise regimen to increase ROM as pain allows

• Following months

  • Periodic increase ROM

• Months 10 to 12

  • Refer to orthopaedics if no improvement or severe restriction

Evidence

• Limited evidence for manual therapy

• Limited effect of oral glucocorticoids beyond a few weeks

• Glucocorticoid injection

  • 3 injections showed benefit, limited evidence for up to 6 injections

• Hydrodilatation

  • One study showed no difference between corticosteroid and corticosteroid with hydrodilatation