Frozen shoulder: adhesive capsulitis.

causes are many: examination must include the glenohumeral joint, the sternoclavicular and acromioclavicular joints, and scapular rotation on the chest wall to distinguish the various conditions. These include arthritis of synovial joints, inflammation of bursae, inflammation and sometimes calcific deposits in the supraspinatus tendon, other rotator cuff lesions, and bicipital tendonitis. Particularly disabling is the development of a painful stiff shoulder, also known as a frozen shoulder or adhesive capsulitis. The pathological basis of frozen shoulder has been described by Neviasa,l who found at surgery a conspicuous absence of synovial fluid in the glenohumeral joint and a tight thickened capsule under tension applied to the humeral head, so limiting shoulder movements. He compared adhesions of the capsule with that of an adhesive plaster on the bare skin-hence the term "adhesive capsulitis." Manipulation of the shoulder tore the adhesions apart and made free movement of the humerus possible. Histological examination of the capsule showed only fibrotic and reparative inflammatory changes. Typically, the symptoms include increasing and severe pain in and around the shoulder with progressive loss of both active and passive glenohumeral movements. In particular, external rotation of the shoulder becomes extremely restricted, with lesser loss of abduction and internal rotation.2 The pain may be severe and may persist throughout the night and lead to considerable distress. Radiographs are usually normal but may show minor osteoporotic or degenerative changes of doubtful importance. Degenerative changes in the neck are common.:3 Arthrography4 shows shrinking of the joint capsule with reduced capacity to accommodate contrast medium. Why frozen shoulder should occur remains uncertain, but some factors are known. The peak incidence5 6 is between 50 and 70 years and is slightly higher in women than men. Frozen shoulder may develop spontaneously but is a particular risk for patients with a hemiplegia or other conditions in which the arm may be immobilised, such as after thoracic surgery, myocardial infarction, and cervical herpes zoster. A prospective study2 of patients admitted to the Atkinson Morley Hospital with cerebrovascular disorders, most of whom underwent