Adhesive Capsulitis

In literature many names, which task is to name this illness, exist for a damage of the articular capsule. This illness is known from the literature as a frozen shoulder, humeroscapular periarthritis, oblitering bursitis etc. If we based our investigations on its name during clarifying of etiology of this disorder, then the capsulitis would be an inflammatory affection of the articular capsule. In the case of diagnosis of adhesive capsulitis we consider only the inner side of the articular capsule1, which is spacious enough to enable the motility of the shoulder joint in all directions without problems, as a primary affected structures. Capsulitis is manifested by shrinkage of the inner part of the articular capsule of the glenohumeral articulation. The glenohumeral joint, firmly wrapped by the articular capsule, cannot move in any direction. The rotator cuff and muscles, which form the cuff, are intact at the beginning, and changes in the cuff are only secondary ones.

Up to now this affection is not exactly defined in medicine. It is obviously necessary to differ up to now!!! inappropriately!! used a clinical diagnosis is which based on  the finding of a restriction of active and passive movements connected with pains. But the same symptoms do not have to be connected only with capsulitis because the same symptoms can have f. e. bursitis, rupture of the rotator cuff, tenovaginitis of the long head of  the biceps also without an affection of the articular capsule. We do not eliminate that most so far diagnosticated cases of adhesive capsulitis was rather in consequences above mentioned processes in the surrounding of the glenohumeral articulation than real adhesive capsulitis. 

The name adhesive capsulitis should be used for real primary capsulitis manifesting itself by a painful restriction of the articular capsule and a global!!! restriction of motility in all directions without presence of primary pathology round lying structures. We have to stress at the beginning of this chapter that we have met only minimum of clinical states which would correspond to diagnosis of adhesive capsulitis2.

If the diagnosis of adhesive capsulitis is not possible on the basis of the clinical finding, what has happened with the diagnostic method of choice for its verification? 

At present a method of choice is thought to be arthrography  which can demonstrate a restriction of the articular capsule, and it simultaneously eliminates an extensive rupture of the rotator cuff. But we think that an entrance ultrasound examination or following MRI, which eliminate above mentioned pathological processes with similar picture, are implicitly necessary.




Clinical Symptoms of Adhesive Capsulitis

Primary capsulitis has three periods, each of them lasts about 3-4 months

Painful period        

A sudden origin of the problems, with a superiority of night problems. Resting pains. A spasm of musculature is developing, and a restriction of motility of the joint.

Adhesive period

It starts with a gradual developing of the restriction of motility and a recession of soresness which is tolerable now in this period.

Period of resolution

In this period a depression of pains and an enlargement of motility which does not have to be wholly altered.


Etiology of Adhesive Capsulitis

Even if the cause of this affection is not known, a consequence with some other affections is obvious. Adhesive capsulitis more often occurs, f. e. at diabetes mellitus (at this disease also bilateral capsulitis can occur??), pulmonary affections, illnesses of  thyroidea or renal insufficiency.


Diagnosis of Adhesive Capsulitis

Diagnosis of adhesive capsulitis is in a finding of :

  1. a restriction of a global motility

  2. an elimination of other pathological states which can be manifested by this picture (ruptures, synovitis, tumours, bursitides etc).

  3. an eventual demonstration at arthrography of the glenohumeral articulation

1not the part formed by the rotator cuff

2about 1-2 cases during 3 years at the examination of more than one thousand patients with pains of the shoulder, namely in the period when we did not examine by means of MRI