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Clinical History and Classification of Adhesive capsulitis

Adhesive capsulitis is a disease that typically progresses through three clinical phases. Patients with this condition will have varying clinical complaints depending upon the phase they are experiencing at the time of interview. The initial inflammatory “painful” phase begins with a spontaneous onset of aching discomfort at rest and the development of pain with use. Pain at night that interferes with sleep commonly occurs and early limitation of motion begins to develop. The arm may be held in an adducted and internally rotated position to reduce tension in the inflamed glenohumeral capsule. Occasionally the patient attributes the onset of their problem to a trivial trauma, but more often no inciting injury can be recalled. This phase may last as long as 9 months. The proliferative or “freezing” phase occurs next and is characterized by progressive and global loss of motion. Range of motion often becomes quite restricted during this portion of the disease process, and it is common for shoulder function to be dramatically reduced by the contracture present. Night pain usually continues, especially when lying on the involved side. Pain with the arm at rest may begin to decrease, although pain with use persists when the patient reaches the end of his or her available motion and the capsule is placed under increased tension. This phase is often described as lasting between 3 to 12 months; however, we have observed it to last significantly longer in numerous patients. The third and final “thawing” phase is characterized by resolution of the painful contracture. The process is often slow and may be punctuated by periods where recovery seems to plateau before resuming its course of progress. Improvement may extend over a period of time ranging from 3 months to 3 years, but it can be prolonged up to 6 or 7 years. Even after the discomfort resolves and acceptable function returns, limitation in final range of motion is commonly present.

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