Question
Can you explain the differences between primary and secondary adhesive capsulitis?
Answer
Primary adhesive capsulitis is defined as a diagnosis for all cases which the underlying etiology or associated condition cannot be identified. In other words, the patients that come in that really have no mechanism or no pre-disposing event that happened, truly an insidious onset. Most literature reports the vast majority of patients presenting with adhesive capsulitis fall into this primary category. Secondary adhesive capsulitis is going to include all cases of frozen shoulder in which there's an underling etiology or associated condition that can be identified. So really our patients' subjective history becomes very important. The secondary category can be broken down a little bit further into three more sub-categories: Intrinsic, extrinsic, and systemic. Intrinsic adhesive capsulitis is something that's happening in association with something inside the shoulder, such as rotator cuff, biceps tendinitis, calcific tendinitis. So there is something going wrong in the shoulder that's now gonna create a problem. Somebody that has a rotator cuff impingement or tear, biceps tendon problem or calcific tendinitis presents with shoulder pain so they will not move it which results in some stiffness. With extrinsic, there's an identifiable abnormality remote to the shoulder itself, but in the same neighborhood. For example, people that have had mastectomy, cervical radiculopathy, a stroke or heart attack, humeral fracture, or AC arthritis is going to impact the soft tissues surrounding the area, may create the need for immobilization, whether it is intended like with a fracture or just for comfort, then start to develop some stiffness. The systemic component within secondary frozen shoulder is associated with systemic disorders such as diabetes, thyroid conditions and then hypoadrenalism.
