Shoulder capsulitis and shoulder-hand syndrome

In shoulder-capsulitis the capsule of the shoulder thickens and adhesions between the capsule and the humeral head occur. The exact pathophysioly is unclear although inflammation, fibrosis and changes in the connective tissue are thought to play a role. The capsulitis results in a 'frozen shoulder' with movement limitation in all directions,

Epidemiology

Shouder capsulitis occurs in 10% of patients with type 1 diabetes, in 25% of patients with type 2 diabetes and in 2% of the general population. In patients with diabetes it is more often bilateral. Diabetes duration seems to be a risk factor, but those with pre-diabetes are also at an increased risk compared to the general population.

Diagnosis and treatment

The diagnosis is made on the clinical symptoms of a frozen shoulder. The course of the disease is usually mild with spontaneous remission within a year. However, incidentally the capsulitis is complicated by shoulder-hand syndrome, a reflex dystrophy of the arm and hand which is accompanied by pain, muscular atrophy and sometimes by contractures of the hand. The pathogenesis of this dystrophy is unclear but entrapment of vessels and nerves in the frozen shoulder may pay a role. The shoulder capsulitis is treated by physical therapy aimed at avoiding immobility and strain of the shoulder. Pain relief and/or corticosteroid injections are sometimes helpful, but the detrimental effects of steroids on glycaemia make repetitive use unattractive unless very strong efficacy is noted. Unfortunately, when reflexdystrophy occurs this is usually irreversible.

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