Evidence-Based Orthopaedics   |    
Adhesive Capsulitis of the ShoulderA Systematic Review of the Effectiveness of Intra-Articular Corticosteroid Injections
Michael J. Griesser, MD1; Joshua D. Harris, MD1; Jonathan E. Campbell, MD1; Grant L. Jones, MD1
1 Department of Orthopaedics, The Ohio State University Medical Center, 2050 Kenny Road, Suite 3300, Columbus, OH 43221. E-mail address for G.L. Jones: grant.jones@osumc.edu
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Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

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Investigation performed at the Department of Orthopaedics, The Ohio State University Medical Center, Columbus, Ohio

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 Sep 21;93(18):1727-1733. doi: 10.2106/JBJS.J.01275
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Primary adhesive capsulitis, or "frozen shoulder," is a common condition encountered in the outpatient orthopaedic clinic. It is characterized by the spontaneous onset of shoulder pain and global limitation of both active and passive shoulder motion. This condition was first described by Codman in 19341 and was most recently defined by the American Academy of Orthopaedic Surgeons as "a condition of varying severity characterized by the gradual development of global limitation of active and passive shoulder motion where radiographic findings other than osteopenia are absent."2 This condition has a prevalence of 2% to 5% in the outpatient setting, but in patients with insulin-dependent diabetes mellitus, the prevalence increases to about 30%3. The pathogenesis of this condition remains unclear, although factors associated with it include female sex, trauma, an age of more than forty years, diabetes, prolonged immobilization, thyroid disease, stroke, myocardial infarction, and the presence of autoimmune disease4. Adhesive capsulitis is commonly described as passing through three stages3-5. Stage 1 is referred to as "freezing" and consists of increasing pain and stiffness lasting for period of as long as nine months. Stage 2 is termed "frozen" and involves a steady state for a period lasting between four and twenty months. Finally, Stage 3 is termed "thawing," which is a period of spontaneous recovery lasting anywhere from five to twenty-six months. This diagnosis is made clinically on the basis of pain and limitation of both passive and active range of shoulder motion. Although typically described as a self-limiting disease process6, the natural history of adhesive capsulitis is not completely known, and recent studies have shown that it can lead to longer-term disability over the course of several years7-10.
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