Frozen Shoulder v Adhesive Capsulitis - What is in a name?
The name of a disease should accurately describe the pathology, using a true description of which patients and healthcare practitioners may best tell the story of what is involved. This becomes especially important when the condition is common, is difficult to diagnose, and is poorly understood, such as is the case with frozen shoulder/adhesive capsulitis. It is also noted that other names are used to describe the disease, such as fibrotic capsulitis, primary idiopathic stiff shoulder, and contracture of the shoulder. What any patient will tell you is missing from the name of this condition is painful and likely severely painful.
Codman in 1934 used the term frozen shoulder to describe the features of, “slow onset pain near the insertion of the deltoid, an inability to sleep on the affected side, painful and restricted elevation and external rotation, and normal radiological appearances (x-ray).”
Neviaser (1945) & Simmonds (1949) suggested the cause was chronic inflammation, a capsulitis. Lundberg (1969) found no significant number of inflammatory cells and suggested that the cause was fibrosis and fibroplasia like Dupuytren’s.
Lundberg also subdivided it into primary or idiopathic versus secondary to soft tissue injury, fracture, arthritis, hemiplegia, surgery, or any other known cause.
The current criteria for primary frozen shoulder modified from Codman’s original criteria by Zuckerman, Cuomo, & Rokito (1994);
i) insidious onset,
ii) true shoulder pain,
iii) night pain,
iv) painful restriction of both active and passive, elevation <100° and external rotation < 1/2 of normal,
v) normal radiological appearance.
Kay & Slater (1981) in one diabetic patient with frozen shoulder found the capsule was identical to those seen in fibromatosis such as Dupuytren’s. Arthroscopic studies (Wiley 1991, Uitvlugt et al 1993, Bunker, et al 1994) and open surgical exploration (Ozaki et al 1989) found the main abnormalities in frozen shoulder are in the rotator interval and anterior capsule. Neer et al (1992) suggested the coracohumeral ligament (CHL) was contracted and Ozaki et al (1989) stated that release of this ligament was curative.
Bunker & Anthony (1995) reported 12 patients who had their coracohumeral ligaments excised and when compared to Dupuytren’s specimens no difference was found. No adhesions were found. We must keep in mind that Bunker & Anthony’s patients were possibly severely affected by the disease, by being from a group of 50 patients referred to a hospital shoulder clinic who failed to respond to i) conservative treatment of having a steroid injection followed by 2 months of physiotherapy (9 improved), and ii) going on to have manipulation under anaesthesia (MUA) (29 improved), and finally requiring CHL surgical release.
Looking at the published science from 1934 – 1995 about this disease the features adhesions and inflammation are not present. Our preference when reporting this disease is to use the term “Frozen Shoulder”.
