INTRODUCTION : Adhesive capsulitis, which is also known as Frozen shoulder is a
common disease affecting the shoulder joint. Codman has stipulated the
diagnostic criteria for adhesive capsulitis and it holds true to this date1. These
criteria include: pain in the shoulder which comes on slowly and is felt at the
insertion of the deltoid, inability to sleep on the affected side, atrophy of the
scapular muscles, and local tenderness. To this date there is no specific sign or
test which is characteristic of Adhesive capsulitis. Recently in a study,
S.Carbone 2et.al, have identified a new clinical test Coracoid pain test, where in
the patients with adhesive capsulitis characteristically demonstrated tenderness
on pressure over Coracoid process. Here in this study, an attempt is made to
validate this Coracoid pressure test in series of patients seen at Physical
Medicine and Rehabilitation department at Kilpauk Medical College Hospital,
Chennai – 10. Patients attending the department were evaluated and a set of age
matched controls were also simultaneously assessed and results were reported.
It was hypothesized that the Coracoid pain test is pathognomonic sign of
Adhesive capsulitis and study makes an unbiased attempt to reach an outcome
based on the analysis.
AIMS AND OBJECTIVES : The primary objective of the study is to consider whether the Coracoid
pressure test, a test proposed by the S.Carbone et al, in their study as a
pathognomic clinical test for adhesive capsulitis is reproducible in our clinical
set up. Here in addition to the conditions like supraspinatus tendinitis, Acromio
clavicular dysfunction, Gleno humeral arthritis, already considered in the
primary study, the response to Coracoid pressure test to cervical brachialgia
with radiating pain down the arm is also considered, which was not considered
in the original article. Age and sex matched controls are also included in the
study and the secondary objective are to study the factors like Diabetes,
occupation and specific overhead activities, religion and injury to the shoulder.
MATERIALS AND METHODS : Government Kilpauk Medical College is one the three government
medical colleges and one of major tertiary care centre in Chennai.
Predominantly the patients come from within the state and particularly from
Chennai.
About 49 consecutive patients with pain around the shoulder referred to
out patient department were included in the study. About 49 persons; age and
sex matched controls were also included in the study subsequently.
Any patient who was assessed for complaints of pain around the neck
and shoulder with a diagnosis of Adhesive capsulitis or supraspinatus tendinitis
or Acromio clavicular dysfunction, or glenohumeral arthritis or finally Cervical
brachialgia is included in the study.
Co existing systemic illness like Diabetes included
Exclusion Criteria:
1. Any patient with either UMN or LMN type of weakness in the shoulder
2. Any surgical procedures on shoulder
3. Patients with ulcerations on anterior shoulder
4. Extremely fatty individuals with difficulty in localizing the coracoids
5. Unable to understand VAS – Visual Analog Scale
6. Pain in the shoulder due to fractures of scapula or coracoids
Patients satisfying these criteria were included in the study and all
patients were assessed according the Performa.
RESULTS : The number of patients taken up consecutively for the study is 49 and
controls 49. The maximum number of cases for adhesive capsulitis falls within 41-55
age group – 17 cases out of 29 cases. In the present study out of 29 cases of adhesive capsulitis the male: female ratio is 17:12. The majority of the patients among the Cases were Hindus. There is an equal distribution of occupation amongst the adhesive capsulitis.
The majority of patients presented within one month of illness. 93% cases (27) did not provided history of the significant trauma to the shoulder. There is equal involvement of both upper limbs. There incidence of the adhesive capsulitis is more in the non diabetic group 16
cases (total 29). In controls study itself there was a significant finding with regards to the
gender issue where normal female persons who don’t have any shoulder
pathology show significant tenderness at the Coracoid process.
CONCLUSION : Considering all the factors and results from this study, the following are
the major conclusions that are arrived.
1. Coracoid pressure test which was proposed by Carbone et al 2 as a
pathognomonic test for Adhesive capsulitis is not supported from this
study.
2. Coracoid pressure test is instead more correlated to the Cervical
brachialgia, as the Coracoid process is the site where muscles,
innervated by the all nerve roots, arise from a common origin. This is a
new clinical finding associated with cervical brachialgia though it is not
specific to cervical brachialgia.
3. Normal females also have different and elevated pain sensitivity,
compared to males; a well accepted finding is also supported in this
study.
4. However, a randomized, controlled, double blind, prospective, large
scale study is required to prove these results.
The other conclusions were
a. The major age incidence of adhesive capsulitis in this study was
between 41 – 55 age category.
b. Males have higher incidence than females in adhesive capsulitis
c. Majority of patients (93%) did not provide the history of significant
trauma to the shoulder in patients with adhesive capsulitis.
d. There is equal side distribution in the incidence of the Adhesive
capsulitis in this study.
e. Contrary to studies47 , the prevalence of the Adhesive capsulitis is more
non diabetics than diabetic patients in this study
