Periarthritis Shoulder (‘Frozen’ Shoulder)

Ans:C.) Frozen shoulder

First image shows thickening of the capsule of the shoulder joint.

Second image shows absent axillary recess. 

Frozen shoulder (adhesive capsulitis)

• A condition characterised by thickening and contraction of the shoulder joint capsule and surrounding synovium.
• It typically affects women in the 5th to 6th decades of life.
• The incidence in patients with diabetes is reported to be 2 to 4 times higher than in the general population.

Clinical presentation:
Adhesive capsulitis presentation can be broken into three distinct stages:

• freezing: painful stage
  • patients may not present during this stage because they think that eventually, the pain will resolve if self-treated.
  • as the symptoms progress, pain worsens and both active and passive range of motion (ROM) becomes more restricted
  • typically lasts between 3 and 9 months and is characterised by an acute synovitis of the glenohumeral joint
• frozen: transitional stage
  • most patients will progress to the second stage
  • because of pain at end ROM, use of the arm may be limited causing muscular disuse
  • can last between 4 to 12 months
  • diminishing motions with external shoulder rotation being the most limited, followed closely by shoulder flexion, and internal rotation
• thawing stage
  • begins when ROM begins to improve
  • lasts anywhere from 12 to 42 months and is defined by a gradual return of shoulder mobility

Radiographic features :

• Fluoroscopic arthrography
  • limited injectable fluid capacity of the glenohumeral joint
  • small subscapularis bursa
  • irregularity of the anterior capsular insertion at the anatomic neck of the humerus
  • lymphatic filling may be present
• Ultrasound
  • Limitation of movement of the supraspinatus is considered a sensitive feature
  • A thickened coracohumeral ligament .
• MRI/MR arthrography
  •  joint capsule thickening
  • abnormal soft tissue thickening within the rotator interval with signal alteration
  • abnormal soft tissue encasing the biceps anchor
  • variable enhancement of the capsule and synovium within the axillary recess and rotator interval
  • absent axillary recess
  • thickening of the coracohumeral ligament (CHL).

Treatment options :

• physiotherapy
• corticosteroid injections
• glenohumeral hydrodilatation
• closed manipulation under anaesthesia
• arthroscopic capsular release with lysis of adhesions

Frozen shoulder (adhesive capsulitis) is stiffness, pain, and limited range of movement in the shoulder. It may happen after an injury or overuse or from a disease such as diabetes or a stroke. The tissues around the joint stiffen, scar tissue forms, andshoulder movements become difficult and painful.