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Adhesive capsulitis (frozen shoulder) — MSRA MCQ

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ModerateShoulder InjuriesAdhesive capsulitis (frozen shoulder)MSRA

A 56-year-old woman presents with a 10-week history of progressive left shoulder pain and stiffness. There was no trauma. Pain is now disturbing sleep and she struggles to dress and reach into cupboards. She has type 2 diabetes treated with metformin; her most recent HbA1c was 50 mmol/mol and she is able to monitor capillary glucose. Regular paracetamol, a short course of ibuprofen, and four weeks of gentle home exercises have provided little benefit. She is afebrile and systemically well. There is no focal bony tenderness, swelling, erythema, sensory loss, or neck pain. Active abduction is 60 degrees and passive abduction is 75 degrees. Active and passive external rotation are both limited to 15 degrees. Strength is preserved when tested in the neutral position. A recent shoulder radiograph is normal. What is the most appropriate management now?

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

Reveal the answer and explanation

Correct answer: D — Offer an intra-articular glenohumeral corticosteroid injection with physiotherapy, advising glucose monitoring

Explanation lettering: C = shown as A · A = shown as B · D = shown as C · E = shown as D · B = shown as E

This is painful-phase adhesive capsulitis: progressive night pain with marked restriction of both active and passive movement, particularly external rotation, and a normal radiograph. Diabetes is a recognised association. Preserved strength in neutral and passive restriction make an acute full-thickness rotator cuff tear less likely; that typically produces disproportionate loss of active movement and weakness with relatively preserved passive range. A corticosteroid injection into the glenohumeral joint can reduce pain sufficiently to facilitate movement and physiotherapy. As she has diabetes, she should be counselled to monitor glucose because transient hyperglycaemia may occur after corticosteroid injection. Physiotherapy should accompany, rather than replace, treatment aimed at pain control in this painful, function-limiting phase. A is inappropriate because manipulation under anaesthesia is not first-line management and is reserved for persistent severe symptoms after non-operative treatment. B is unnecessary: the clinical pattern and normal radiograph support adhesive capsulitis, without features suggesting cuff rupture, fracture, malignancy, infection, or neurological disease. C uses the wrong target: a subacromial injection is more appropriate for rotator cuff-related subacromial pain. D is plausible, but physiotherapy alone is less suitable here because severe pain has persisted despite initial measures and is limiting participation in rehabilitation.

Reference: Frozen shoulder (Page last reviewed 24 June 2024) — https://www.nhs.uk/conditions/frozen-shoulder/