Pathology
Stages of Adhesive Capsulitis
Stage 1 (0-3 months)
Pain: active and passive ROM
Limitations: forward flexion, abduction, internal rotation, external rotation
Examination with the patient under anaesthesia: normal or minimal loss of ROM
Arthroscopy: diffuse glenohumeral synovitis especially in anterosuperior capsule
Pathologic changes: hypertrophic, hypervascular synovitis, rare inflammatory cell infiltrates, normal underlying capsule.
Stage 2 'Freezing' (3-9 months)
Pain: chronic on active and passive ROM
Limitations: of forward flexion, abduction, internal rotation, external rotation
Examination with the patient under anaesthesia: ROM identical to ROM when patient is awake
Arthroscopy: Diffuse pedunculated synovitis (tight capsule with rubbery or dense feel on insertion of arthroscope
Pathologic changes: hypertrophic, hypervascular synovitis, with perivascular and subsynovial scar, fibroplasia and scar formation in the underlying capsule
Stage 3 'Frozen'(9 weeks to 5 months)
Pain : only at end ROM
Limitations: Significant lack of ROM in all planes with rigid “end feel”
Examination with the patient under anaesthesia: ROM identical to ROM when patient is awake
Arthroscopy: No hypervascularity seen. Remnants of fibrotic synovium can be seen. The capsule feels thick in insertion of the arthroscope and there is a diminished capsular volume.
Pathologic changes: “burned out” synovitis without significant hypertrophy or hyper vascularity. Underlying capsule shows dense sear formation.
Stage 4 'Thawing' (15-24 Months)
Pain: minimal
Limitations: Progressive improvement in ROM, regaining functional movements for daily activities
(Hannafin, JA & Chiaia, 2000)
Pain: active and passive ROM
Limitations: forward flexion, abduction, internal rotation, external rotation
Examination with the patient under anaesthesia: normal or minimal loss of ROM
Arthroscopy: diffuse glenohumeral synovitis especially in anterosuperior capsule
Pathologic changes: hypertrophic, hypervascular synovitis, rare inflammatory cell infiltrates, normal underlying capsule.
Stage 2 'Freezing' (3-9 months)
Pain: chronic on active and passive ROM
Limitations: of forward flexion, abduction, internal rotation, external rotation
Examination with the patient under anaesthesia: ROM identical to ROM when patient is awake
Arthroscopy: Diffuse pedunculated synovitis (tight capsule with rubbery or dense feel on insertion of arthroscope
Pathologic changes: hypertrophic, hypervascular synovitis, with perivascular and subsynovial scar, fibroplasia and scar formation in the underlying capsule
Stage 3 'Frozen'(9 weeks to 5 months)
Pain : only at end ROM
Limitations: Significant lack of ROM in all planes with rigid “end feel”
Examination with the patient under anaesthesia: ROM identical to ROM when patient is awake
Arthroscopy: No hypervascularity seen. Remnants of fibrotic synovium can be seen. The capsule feels thick in insertion of the arthroscope and there is a diminished capsular volume.
Pathologic changes: “burned out” synovitis without significant hypertrophy or hyper vascularity. Underlying capsule shows dense sear formation.
Stage 4 'Thawing' (15-24 Months)
Pain: minimal
Limitations: Progressive improvement in ROM, regaining functional movements for daily activities
(Hannafin, JA & Chiaia, 2000)