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.
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.
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
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.
Primary capsulitis has three periods, each of them lasts about 3-4 months
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.
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.
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 is in a finding of :
a restriction of a global motility
an elimination of other pathological states which can be manifested by this picture (ruptures, synovitis, tumours, bursitides etc).
an eventual demonstration at arthrography of the glenohumeral articulation
1not the part formed by the rotator cuff2about 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