What is the diagnosis?

Adhesive capsulitis, which is colloquially known as frozen shoulder. It is an inflammatory condition that causes fibrosis of the GH capsule.

• Pearl: It affects 2-5% of the population. It usually presents as gradually progressive stiffness with reduced range of motion, however some patients may develop symptoms precipitously [1].

• Pearl: Adhesive capsulitis can be primary (idiopathic) if it occurs spontaneously without any trauma, or secondary that is seen after a periarticular fracture or dislocation of the GH joint or other severe joint trauma.

What physical examination findings are expected?

Patients may have diffuse tenderness along the shoulder.. Most commonly, patients will have reduced range of motion in all planes, especially with external rotation.

• Pearl: Patients may also present with muscle atrophy in advanced cases due to disuse of the shoulder muscles.

What imaging modality is needed for the diagnosis

None! Adhesive capsulitis is a clinical diagnosis using history and exam findings that show marked reduced active and passive range of motion.

• Pearl: Imaging, such as ultrasound, MRI, and arthrography are useful in excluding concomitant painful conditions and can aid in the diagnosis, however are not needed for a diagnosis [2].

• Pearl: Routine imaging with X-ray is not beneficial. A retrospective review found that routine X-ray to rule out masquerading pathology is not needed [3].

What is the management in the ED? Do you need to consult orthopedics?

Management in the ED should focus on pain control. Patients can be given an NSAID to help with the pain and inflammation, however the main treatment is addressed in the outpatient setting. A corticosteroid injection can also be considered in the ED. Patients should see physical therapy for ROM exercises that are crucial for long-term management.

• Pearl: Other treatment options include US -guided suprascapular nerve block or digestion arthrography/hydrodilatation [3].

Orthopedic surgery consultation in the ED is not needed. If the patient does not respond to the above more conservative measures, they may be referred to orthopedic surgery to discuss arthroscopic capsular release, a minimally invasive surgery done to remove scarring and parts of the inflamed capsule.