MSK: Adhesive Capsulitis: Free MSRA Podcast

🧊 Adhesive Capsulitis (Frozen Shoulder) – Deep Dive RapidReview DefinitionAdhesive capsulitis (aka frozen shoulder) is a condition causing progressive pain and severe restriction of both active and passive movement of the shoulder, due to inflammation and subsequent fibrosis of the glenohumeral joint capsule. PathophysiologyStage 1: Inflammation of the capsuleStage 2: Fibrosis and thickeningStage 3: Adhesions and shrinkageResult: “Sticky” capsule, less synovial fluid, movement restricted Phases (Easy mnemonic: Freezing – Frozen – Thawing)Freezing Phase (painful phase):Gradual onset of pain and increasing stiffness (2–9 months)Frozen Phase (adhesive phase):Marked stiffness, pain may reduce (4–12 months)Thawing Phase (recovery phase):Gradual improvement in movement, minimal pain (1–3 years) Causes / Risk FactorsIdiopathic (most cases)Diabetes mellitus (up to 20% prevalence!)Thyroid disorders (esp. hypothyroidism)Prolonged shoulder immobilisation (e.g. after injury/surgery)Previous shoulder injuryFemale > male (slightly)Age > 40 (peak 40–60 years)Other associations: Autoimmune disease, cardiovascular disease Clinical FeaturesGradual onset shoulder pain (often severe, worse at night)Marked restriction of active AND passive movement—especially external rotation (classic!)Stiffness follows painImpact on ADLs: Reaching overhead, dressing, hair care, sleeping Differential DiagnosisRotator cuff tear/tendinopathySubacromial bursitisOsteoarthritis (shoulder)Shoulder impingement syndromeReferred pain (e.g. cervical radiculopathy) DiagnosisClinical diagnosis:History + exam (restricted passive external rotation is the key sign!)Imaging (if atypical or not improving):X-ray – to rule out arthritis, calcific tendonitis, fracture (often normal in adhesive capsulitis)MRI/US – if suspicion for other pathology ManagementConservative (First-line)Analgesia: Paracetamol, NSAIDs (if suitable)Physiotherapy:Gentle, progressive stretching and mobilisationManual therapy techniquesCorticosteroid injection:Intra-articular for severe pain or early phases (can facilitate physio)If persistent / severeReferral to orthopaedics:Manipulation under anaesthesia (MUA)Arthroscopic capsular release (keyhole surgery)General AdviceEncourage gentle movement within pain limitsReassure: Most cases improve over 1–3 years (self-limiting) PrognosisGenerally good – majority recover full or near-full functionPossible complications:Persistent mild pain or stiffnessSecondary shoulder pathology (rotator cuff, impingement)Rare: permanent restriction of movement ComplicationsChronic pain/stiffnessFunctional impairmentMuscle weakness from disuseRisk of other shoulder injuries Key Memory AidsPhases: Freezing – Frozen – ThawingMovement most affected: Passive external rotationTop association: Diabetes MSRA Revision ResourcesAdhesive Capsulitis Revision NotesFlashcardsAccordion Q&A NotesRapid Fire QuizQuizMain revision sites:PassTheMSRA.comFreeMSRA.com #MSRA#AdhesiveCapsulitis #FrozenShoulder #MSRARevision #Musculoskeletal #PassTheMSRA#FreeMSRA