Neviaser distinguishes adhesive capsulitis as a specific pathologic entity, separate from the loosely used term "frozen shoulder." Using arthroscopy, the paper defines four stages of the disease based on synovial changes and dependent fold contracture. It also details diagnosis by arthrogram and management from conservative therapy through manipulation and open release.
The key teaching point is that a stiff painful shoulder failing impingement treatment may actually be early adhesive capsulitis. When you see minimal motion loss but persistent pain that does not respond to standard impingement care, think stage 1 disease before offering acromial decompression. Operating on this shoulder can trigger the full staged course superimposed on a surgical recovery.
The pathology lives in the dependent fold of the inferior capsule, which is why manipulation targets pure glenohumeral abduction with the scapula fixed. Understanding this anatomy explains both the arthrographic finding (loss of the fold, low injectable volume) and the manipulation sequence.
Management follows a clear order: conservative passive stretching first, manipulation under anesthesia only after failure, and open release when adhesions cannot be broken safely. During open release remember the axillary nerve lies posteriorly at the inferior fold.
Neviaser distinguishes adhesive capsulitis as a specific pathologic entity, separate from the loosely used term "frozen shoulder." Using arthroscopy, the paper defines four stages of the disease based on synovial changes and dependent fold contracture. It also details diagnosis by arthrogram and management from conservative therapy through manipulation and open release.
The key teaching point is that a stiff painful shoulder failing impingement treatment may actually be early adhesive capsulitis. When you see minimal motion loss but persistent pain that does not respond to standard impingement care, think stage 1 disease before offering acromial decompression. Operating on this shoulder can trigger the full staged course superimposed on a surgical recovery.
The pathology lives in the dependent fold of the inferior capsule, which is why manipulation targets pure glenohumeral abduction with the scapula fixed. Understanding this anatomy explains both the arthrographic finding (loss of the fold, low injectable volume) and the manipulation sequence.
Management follows a clear order: conservative passive stretching first, manipulation under anesthesia only after failure, and open release when adhesions cannot be broken safely. During open release remember the axillary nerve lies posteriorly at the inferior fold.