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Classifications for Adhesive Capsulitis

adhesive capsulitis classification frozen shoulder shoulder pain

Frozen Shoulder: Lundberg Classification (Lundberg et al., 1969)

  1. Primary frozen shoulder:
  • Shoulder elevation <135 deg
  • Limitation of movement only at gleno-humeral articulation
  • Radiology normal
  • Other causes ie trauma, OA, RA, Hemiplegia etc excluded
  1. Secondary frozen shoulder:
  • Decreased range of movement following trauma or other known cause

Stages of Frozen Shoulder: Reeves Classification (Reeves, 1975)

  1. Painful stage: 10-36 weeks
  2. Stiffness: 4-12 months
  3. Recovery: 5-24 months

 

Arthroscopic stages of Frozen Shoulder: Nevasier Classification (Nevasier, 1987)

Stage 1:  Erythematous/ fibrinous synovium

  • patient presents as impingement

Stage 2:  Red, angry, thick synovium,

  • thick, contracted interval, tight joint space adhesions in the inferior fold

Stage 3:  Pink synovium

  • contracted inferior fold, tight joint space

Stage 4:  no evidence of synovitis

  •  tight inferior fold and joint

 

Four Clinical Stages of Adhesive Capsulitis (Hannafin & Chiaia, 2000)

  1. Painful stage
    • Characterized by pain and progressive restriction of movement. This phase is characterized by hypertrophic synovitis with hypervascularity, but a normal appearance of the capsular tissue.
  2. Freezing stage
    • Histologically, there is perivascular synovitis and collagen deposition.
  3. Frozen stage
    • Characterized by stiffness as a predominating symptom.
  4. Thawing stage
    • The formation of dense collagenous tissue in the capsule, associated with scar formation.

References

  1. Lundberg BJ. The frozen shoulder. Clinical and radiographical observations. The effect of manipulation under general anesthesia. Structure and glycosaminoglycan content of the joint capsule. Local bone metabolism. Acta Orthop Scand Suppl. 1969;119:1-59.
  2. Reeves B. The natural history of the frozen shoulder syndrome. Scand J Rheumatol. 1975;4(4):193-196. doi:10.3109/03009747509165255
  3. Neviaser TJ. Adhesive capsulitis. Orthop Clin North Am. 1987;18(3):439-443.
  4. Hannafin JA, Chiaia TA. Adhesive capsulitis. A treatment approach. Clin Orthop Relat Res. 2000;(372):95-109.

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