eMedicine Specialties > Orthopedic Surgery > Shoulder

Adhesive Capsulitis: Workup

Author: Albert W Pearsall IV, MD, Associate Professor, Department of Orthopedic Surgery, University of South Alabama; Director, Section of Sports Medicine and Shoulder Service, Department of Orthopedic Surgery, University of South Alabama Medical Center
Contributor Information and Disclosures

Updated: Aug 12, 2008

Workup

Laboratory Studies

  • Laboratory studies rarely are required for the evaluation of adhesive capsulitis. However, if a predisposing medical condition that may be contributing to adhesive capsulitis is suggested, the following tests may be ordered:
    • CBC
    • Erythrocyte sedimentation rate (ESR)
    • C-reactive protein
    • Serum blood sugar
    • Thyroid stimulating hormone (TSH)
    • Free thyroxine index (FTI)
  • Although an orthopedic surgeon may order these tests, results should be forwarded to the patient's internist for further evaluation.

Imaging Studies

  • Routine radiographs of the shoulder should be obtained in all cases to rule out any pathologic process. These radiographs should include the anteroposterior (AP) view of the glenohumeral joint in neutral rotation, the supraspinatus outlet view, and the axillary lateral view (if possible).
  • Magnetic resonance imaging (MRI) is not initially indicated in cases of adhesive capsulitis. Due to the global pain associated with frozen shoulder, MRI is an expensive and nonspecific test. However, if the patient does not improve after a period of time (6 wk to 3 mo), then MRI is appropriate to rule out a possible rotator cuff tear or intra-articular pathology.

Histologic Findings

Many patients with adhesive capsulitis demonstrate arthroscopic evidence of proliferative synovitis, capsular and intra-articular subscapularis tendon thickening, and fibrosis and chronic inflammatory cells. The majority of significant synovitis is noted, although it is not limited to the anterior capsule. In addition, most patients demonstrate significant subacromial fibrosis. In one study, the author noted that approximately 40% of patients had significant subacromial fibrosis, regardless of preoperative etiology.

More on Adhesive Capsulitis

Overview: Adhesive Capsulitis
Workup: Adhesive Capsulitis
Treatment: Adhesive Capsulitis
Follow-up: Adhesive Capsulitis
Multimedia: Adhesive Capsulitis
References
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Further Reading

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Keywords

adhesive capsulitis, frozen shoulder, frozen shoulder syndrome, FSS, bursitis, joint disease, capsulitis shoulder, adhesive shoulder, adhesive joint, frozen shoulder treatment, shoulder pain, stiff shoulder

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Contributor Information and Disclosures

Author

Albert W Pearsall IV, MD, Associate Professor, Department of Orthopedic Surgery, University of South Alabama; Director, Section of Sports Medicine and Shoulder Service, Department of Orthopedic Surgery, University of South Alabama Medical Center
Disclosure: Nothing to disclose.

Medical Editor

Lynn A Crosby, MD, FACS, Chief of Shoulder Division, Professor, Department of Orthopedic Surgery, Wright State University School of Medicine
Lynn A Crosby, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American College of Sports Medicine, American College of Surgeons, American Fracture Association, American Medical Association, American Medical Tennis Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Arthroscopy Association of North America, Mid-America Orthopaedic Association, and Orthopaedic Research Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Pekka A Mooar, MD, Professor, Department of Orthopedic Surgery, Temple University School of Medicine
Pekka A Mooar, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Mary Ann E Keenan, MD, Professor, Vice Chair for Graduate Medical Education, Department of Orthopedic Surgery, University of Pennsylvania School of Medicine; Chief of Neuro-Orthopedics Program, Department of Orthopedic Surgery, Hospital of the University of Pennsylvania
Mary Ann E Keenan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, American Society for Surgery of the Hand, and Orthopaedic Rehabilitation Association
Disclosure: Nothing to disclose.

 
 
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