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Adhesive capsulitis — SCE Rheumatology MCQ

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ModerateOsteoarthritis and soft tissue rheumatologyAdhesive capsulitisSCE Rheumatology

A 55-year-old man with well-controlled type 2 diabetes has an 8-week history of progressive atraumatic shoulder pain that disturbs his sleep. Active and passive external rotation are both restricted to less than 50% of the range in the opposite shoulder. Strength is preserved within the available range, and plain radiographs show no glenohumeral arthritis or other bony abnormality. What is the most appropriate next management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Intra-articular glenohumeral corticosteroid injection with analgesia and early structured physiotherapy

The correct answer is A. Marked restriction of both active and passive external rotation, with normal radiographs and preserved strength within the available range, is characteristic of adhesive capsulitis rather than a rotator-cuff tear. In the painful phase, UK practice supports analgesia, early gentle stretching or structured physiotherapy, and an intra-articular glenohumeral corticosteroid injection for short-term pain and disability relief. Because he has diabetes, confirm reasonable glycaemic control, discuss transient post-injection hyperglycaemia and advise increased glucose monitoring for 24–48 hours. Immobilisation may worsen stiffness, and systemic prednisolone is not standard treatment. A subacromial injection does not target the contracted glenohumeral capsule. Arthroscopic capsular release is reserved for persistent, severe symptoms despite an adequate trial of non-operative treatment.

Reference: Brealey S et al. Surgical treatments compared with early structured physiotherapy in secondary care for adults with primary frozen shoulder: the UK FROST three-arm RCT. Health Technology Assessment. 2020;24(71):1–162. https://pubmed.ncbi.nlm.nih.gov/33292924/