The scapulohumeral articulation is the place where the scapula and the humerus meet. The term ankylosis refers to a stiff, immobile joint. Ankylosis of the scapulohumeral joint is referred to as adhesive capsulitis, and may follow conditions such as bursitis or tendonitis which involve prolonged immobility of the joint.

The condition may be associated with the development of ankylosis in association with systemic disorders such as: diabetes mellitus, myocardial infarction, cervical radiculopathy, and chronic lung disease. It may also occur from specific alterations in the scapulohumeral articulation including bone spurs, ligament injuries, or hypertrophy of tendonous structures.

Characteristic manifestations of the condition include: acute shoulder pain, which may interfere with sleep; stiffness, restricted, active, and passive motion of the shoulder; and tenderness of the area upon palpation.

An arthrography will demonstrate a reduced joint size when it is filled with contrast material. X-rays reveal osteopenia in the shoulder. Ultrasonography can be used to diagnose rotator cuff disease. Magnetic resonance imaging (MRI) has demonstrated a sensitivity and specificity of 100% and 95% respectively.

After several months, if full range of motion is not restored, then forceful injections of contrast material into the joint is done to break up scar tissue and to stretch the capsule. This treatment is done under general anesthesia along with shoulder manipulation to free adhesions. Local injections of anti-inflammatory medications and glucocorticoids may provide some relief. Arthroscopic versus open acromioplasty is indicated in patients that have failed non-operative treatment.

• There may be some permanent restriction of movement, but, with continued physical therapy of the arm and shoulder, the degree of ankylosis may be lessened.

• When deciding expressly claimed issues, decision makers must consider entitlement to any complications that are within scope of the claim, including those identified by the rating criteria for that condition in 38 CFR Part 4. This could include but is not limited to, scars as the result of surgical intervention for an SC disability. 

• The rating schedule for musculoskeletal was updated on February 7, 2021. Protection still does apply and should be considered with existing evaluations (38 CFR 3.951(a)).

• Multiple precedential decisions have impacted the application of 38 CFR 4.59 for musculoskeletal disabilities.  Refer to the table in the M21-1 for a listing of impactful precedential court holdings, a brief description of the impact, and the applicability date (date of decision) for each. 

• It is the responsibility of the rating specialist to interpret reports of examination in the light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability present. See 38 CFR 4.2 – Interpretation of examination reports. If the report or examination is inadequate, the rating agency may return for a supplementary report. See 38 CFR 4.70 – Inadequate examinations. 

• The scapula and humerus move as one piece.