A patient admitted with adhesive capsulitis presents with an insidious onset of pain and stiffness over the past several months. Which patient profile is MOST likely associated with this diagnosis?

• A. 58-year-old female with multiple sclerosis
• B. 45-year-old male with peripheral neuropathy
• C. 52-year-old male with recurrent rotator cuff tendinopathy
• D. 48-year-old female with diabetes

Answer: (D)

Adhesive capsulitis, or frozen shoulder, is strongly linked to diabetes because metabolic changes from hyperglycemia promote fibrosis and thickening of the shoulder joint capsule. Nonenzymatic glycation of collagen leads to cross-linking and stiffening of the capsular tissue, with inflammatory mediators driving synovial proliferation and adhesions. Clinically, it presents as a gradual, insidious onset of pain and progressive loss of range of motion, often with a capsular pattern where external rotation is most limited, followed by abduction and internal rotation. The profile with diabetes fits this pattern and risk, making it the most likely association.

The other profiles don’t align as closely with adhesive capsulitis. Multiple sclerosis is a central nervous system condition rather than a known risk factor for this shoulder pathology; peripheral neuropathy can cause shoulder symptoms but not the classic capsular restriction pattern; recurrent rotator cuff tendinopathy causes more focal pain and weakness with different movement limitations rather than the diffuse, progressive ROM loss characteristic of a stiff, fibrotic capsule.