''X-ray normal shoulder joint, though patients complaints of pain and limited ROM with characteristic freezing, frozen and thawing phases that span over a period of average 18-months" - a definition is commonly used to describe frozen shoulder syndrome (FSS). However, in my practice, I do explore some patients with such symptoms-signs complex under high-frequency musculoskeletal ultrasonogram with the features simulating with SASD bursitis, AND or supraspinatus tear (partial or complete), AND or bicipital tenosynovitis. So, traditional definition of FSS should be challenged, especially in situations where common risk factors such as diabetes mellitus, hypothyroidism, hyperthyroidism, dyslipidemia, trauma, ischemic heart disease, etc. for the disorder are absent.
There seem to be other factors too. Kindly refer to this article
Le, H. V., Lee, S. J., Nazarian, A., & Rodriguez, E. K. (2017). Adhesive capsulitis of the shoulder: review of pathophysiology and current clinical treatments. Shoulder & elbow, 9(2), 75–84. https://doi.org/10.1177/1758573216676786
Prior authors have noted additional conditions besides idiopathic adhesive capsulitis. You are correct in identifying possible influence from degenerative athritis, post-traumatic stiffness, rotator cuff tear, labral tear, fracture malunion, diabetes, thyroid disorder, and postop stiffness. Diabetes' role in contracture pathophysiology is still somewhat of a mystery, presenting with greater pain and nonresponsivity to conservative therapy than nondiabetic IAC. Patients can also present with GH contractures following surgery without capsular insult.
Michael C. Meyers, thank you so much for your addition. My question is that whether defining adhesive capsulitis alongside clinical features only normal X-ray shoulder is enough or not. To delineate soft soft tissue pathology contributing frozen shoulder-like features, besides X-ray, cost-effective musculoskeletal ultrasonogram (MSUS) could be handy. So, there could be slight modification of current frozen shoulder syndrome definition - ''X-ray and MSUS normal shoulder joint, though patients complaints of pain and limited ROM with characteristic freezing, frozen and thawing phases that span over a period of average 18-months".
Michael C. Meyers, Should we use frozen shoulder syndrome synonymously with adhesive capsulitis? What is your opinion.
I would say no, if the word 'syndrome' is used--which denotes a group of symptoms which characteristically occur or are associated together. Using 'adhesive capsulitis' alone should technically indicate that other pathophysiology have been ruled out. Also, if you think about it, using the terms 'frozen shoulder' and 'syndrome' together might be considered redundant, since the early use of 'frozen shoulder' was a catch-all term meant to include any and all factors contributing to the condition. That being said, although how we communicate is important, words and phrases will continue to be misused, depending on where an individual has been educated, medically trained, etc. Which, ultimately, as we are discussing here, causes confusion but certainly provides for a healthy dialogue.
Thank you, sir. We could consider- "All the adhesive capsulitis leads to frozen shoulder syndrome (FSS), but not all the FSS is due to mere capsular adhesion between glenoid cavity and humeral head; to exclude pathology manifesting features alike FSS, mere radiological normality is not enough, advanced imaging like MSUS can unveil structure involved".
I would agree with your summation. I enjoyed the conversation--colleagues should have more thoughtful dialogue like this.
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