Regarding Frozen Shoulder (Adhesive Capsulitis)

Which of the following diseases is associated with frozen shoulder (adhesive capsulitis)?
A. Diabetes mellitus
B. Osteoarthritis
C. Hypertension
D. Pregnancy

E. Gout

Answer  A. Diabetes mellitus

Discussion: Adhesive capsulitis and frozen shoulder syndrome (FSS) are two terms that have been used to describe a painful and stiff shoulder. 

It occurs when the shoulder capsule, the connective tissue surrounding the glenohumeral joint of the shoulder, becomes inflamed and stiff, greatly restricting motion and causing chronic pain. Pain is usually constant, worse at night, and with cold weather. Certain movements or bumps can provoke episodes of tremendous pain and cramping. The condition is thought to be caused by injury or trauma to the area and may have an autoimmune component.

Signs and symptoms typically begin gradually, worsen over time and then resolve, usually within one to three years.

Risk factors for frozen shoulder include :

• tonic seizures, 
• diabetes mellitus, 
• stroke, 
• accidents, 
• lung disease, 
• connective tissue diseases, 
• thyroid disease, and 
• heart disease.

Secondary adhesive capsulitis is associated with many conditions. Diabetes, myocardial infarction, stroke, thyroid disease, and rheumatoid arthritis are all linked to frozen shoulder. However, the mechanisms are unclear, whether it is due to trauma, autoimmune reaction, inflammatory conditions, or a combination of these. 

Although the diagnosis of adhesive capsulitis is usually made clinically, arthrography is the imaging test of choice to document decreased joint volume if the diagnosis is unclear. It is an invasive test but can definitively demonstrate loss of joint volume.

Treatment for frozen shoulder involves range-of-motion exercises and, sometimes, corticosteroids and numbing medications injected into the joint capsule. In a small percentage of cases, arthroscopic surgery may be indicated to loosen the joint capsule so that it can move more freely.