3 Adhesive Capsulitis

Question 1

What is adhesive capsulitis?

Answer 1

Pain and stiffness or motion loss in the shoulder

associated with sleep deprivation, anxiety, and disability

Avg duration 30 months

Generall 40-60 year old patients

Females > males

Uknown cause

Question 2

What does adhesive capsulitis result in?

Answer 2

Hardening of redundant axillary folds

Synovial capsule thickening

Contracture of GH joint

Dense adhesions of synovial capsule

significant loss of A/PROM

Question 3

What is the primary cause of Frozen shoulder?

Answer 3

Unknown

Question 4

What are some secondary causes of frozen shoulder?

Answer 4

Systemic

• Diabetes, Hypothyroidism, hyperthoidyism, hypoadrenalism

Extrinsic

• Cardiopulmonary disease, CVA, humerus fractures, parkinsons

Intrinsic

• RC tendonitis, RC tear, biceps tendinitis, AC arthrits, Calcific tendinitis

Question 5

3 histological changes of adhesive capsulitis

Answer 5

• Inflammatory cytokines
• Fibroblasts - myofibroblasts
  
  • fibroblasts = more collagen
  • Myofibroblats = contractile
• Lymphocytes

Question 6

Pathogenesis of frozen shoulder

Answer 6

Arthrogram

Signficant loss of fluid volume in joint capsule

(normal 28-35ml)

Primary: Neuronal and vascular abnormalities - increased vascularity in anteriosuperior but not inferior or posterior capsule

Question 7

Stage 1 Adhesive capsulitis

Answer 7

0-3 months

non capsular limitations

pain with A/PROM

Question 8

Stage 2 Adhesive Capsulitis

Answer 8

“freezing”

3-9 months

Capsular pattern limitation

Question 9

Stage 3 Adhesive capsulitis

Answer 9

“frozen”

9-15 months

High irritability

Rigid end feel

Question 10

Stage 4 AC

Answer 10

“thawing”

15-24 months

low irritibility

Gradual return ROM

Question 11

What is the patient presentation for frozen shoulder?

Answer 11

• Gradual and progressive onsent of pain
• pain at end ranges of movements
• patients present with painful/restricted A/PROM in both elevation and rotation for at least 1 month
• Functional activities reaching OH, HBB, or abduction = difficult

Question 12

What is the capsular pattern presence in frozen shoulder?

Answer 12

ER limitations > ABD limitations > IR limitations

Question 13

What are some management options for Adhesive capsulitis?

Answer 13

Wait and see (lack of evidence)

PT

Corticosteriod injections > oral steriod

Manipulation

Arthoscopy

(so nigificant difference between surgical and non surgical)