Adhesive Capsulitis Workup

  • Author: Albert W Pearsall IV, MD; Chief Editor: Mary Ann E Keenan, MD   more...
 
Updated: Dec 2, 2011
 

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.
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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).[19]
  • 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.[20]
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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.

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Contributor Information and Disclosures
Author

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

Disclosure: Nothing to disclose.

Specialty Editor Board

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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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.

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

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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True anteroposterior view of the glenohumeral joint (left); axillary lateral view (middle); supraspinatus outlet view (right)
Table 1.
Corticosteroid Dosing in Patients With Refractive Frozen Shoulder Syndrome*
Week NumberMedicationDose
1 (Days 1-7)Prednisone40 mg/d
2 (Days 8-14)Prednisone30 mg/d
3 (Days 15-18)Prednisone20 mg/d
4 (Days 19-21)Prednisone10 mg/d
5 (Days 22+)Discontinue----
*Before oral corticosteroid medication is prescribed, the patient should be extensively questioned about pertinent medical problems that may be contraindications to taking the medicine.
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