Adhesive Capsulitis in Post-Stroke Patients

Risk Factors and Pathophysiology

Up to 67% incidence of shoulder-hand-pain syndrome is observed in stroke patients with combined motor, sensory, and visuoperceptual deficits 1
Improper handling during rehabilitation, such as overhead pulley exercises, can increase the risk of hemiplegic shoulder pain in post-stroke patients 2
Shoulder tissue injury, including effusion, tendinopathy, or rotator cuff tears, is found in approximately one-third of acute stroke patients and may contribute to capsulitis 2
Spasticity correlates with the development of shoulder complications in post-stroke patients, although definitive causation remains unconfirmed 2
Inadequate protection of the hemiplegic limb can increase the risk of trauma and subsequent capsulitis 2

Bone scintigraphy demonstrates increased periarticular activity in adhesive capsulitis 3
Triple phase bone scan shows increased periarticular uptake in distal upper extremity joints when shoulder-hand syndrome is present 2
Adhesive capsulitis can delay rehabilitation and functional recovery in post-stroke patients, potentially masking motor function improvement or inhibiting the use of assistive devices 1, 3
Delayed rehabilitation due to pain can limit participation in therapy and use of canes or wheelchairs for ambulation 1
Depression and sleeplessness can contribute to reduced quality of life in patients with adhesive capsulitis 3

The rotator interval and axillary recess are commonly involved in capsular thickening and contracture 2
External (lateral) rotation is the most significantly affected motion and relates strongly to the onset of shoulder pain 1
Abduction is severely restricted in the frozen stage of adhesive capsulitis 1, 2
Metacarpophalangeal and proximal interphalangeal joints can show pain, tenderness, and edema when shoulder-hand syndrome develops 2
The subacromial region may be involved when pain relates to injury or inflammation of this area 2
The subscapularis and pectoralis muscles can contribute to pain when spasticity is present 2

The American College of Rheumatology suggests that degenerative joint disease or osteoarthritis, soft tissue rheumatic disorders, crystal arthropathies, and septic arthritis can produce a similar clinical picture to adhesive capsulitis and must be excluded, with the key distinguishing feature being equal restriction of both active and passive motion in all planes, particularly external rotation, in adhesive capsulitis 4