(Kiosk 2) The Chicken or the Egg: A Case Report of Adhesive Capsulitis in the Setting of Chronic Cervical Radiculopathy

Case Diagnosis: A 52-year-old woman with cervical radiculopathy and concomitant adhesive capsulitis.

Case Description or Program Description: The patient presented to the physiatry clinic for left shoulder pain and inability to raise her arm with onset more than 6 months ago. The patient’s past medical history was significant only for cervical spine degenerative joint disease (DJD) diagnosed 7 years ago. She reported taking meloxicam and cyclobenzaprine with partial relief, denying any inciting event. The shoulder pain was intermittent and associated with neck pain, worsening in severity and frequency since onset.

Setting: Outpatient Adult Musculoskeletal Rehabilitation Clinic

Assessment/Results: Physical exam was significant for a positive Spurling’s sign and Hoffman’s reflex on the left. Diagnostic studies included X-ray, magnetic resonance imaging (MRI), and electrodiagnostic studies (EDx). X-ray showed joint spaces of the glenohumeral joint and acromioclavicular joint were maintained. MRI of the left shoulder ruled out rotator cuff tear and revealed soft tissue findings consistent with adhesive capsulitis. MRI of the cervical spine showed C4-5 disc protrusion and left C4-5 foraminal narrowing. EDx showed polyphasic motor units in the left deltoid and rhomboids consistent with chronic left C5 radiculopathy with reinnervation.

Discussion (relevance): The workup of this patient’s left shoulder pain identified two etiologies of the patient’s symptoms: C5 radiculopathy and adhesive capsulitis. We can only speculate which of these distinct pathologies began first. Possibly, the patient’s known cervical DJD lead to left C4-5 foraminal stenosis, impinging the C5 nerve root causing the C5 radiculopathy found on EDx causing reduced mobility. Reduced mobility, in turn, may predispose to adhesive capsulitis. Multimodal treatment targeted both etiologies of the patient’s symptoms.

Conclusions: The physiatrist should maintain a broad differential and be aware of confounding sources of pain and limited range of motion. Shoulder and cervical pathologies can overlap or refer pain to the other. Furthermore, cervical radiculopathy is a less common predisposing condition to adhesive capsulitis.