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MSK 1 > 9/20 - Adhesive Capsulitis > Flashcards

9/20 - Adhesive Capsulitis Flashcards

1
Q

what is frozen shoulder a general term for

A

any shoulder condition consisting of pain and limited ROM

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2
Q

what is characteristic of frozen shoulder syndrome as a pathology or dx

A

self limiting

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3
Q

what is adhesive capsulitis

A

inflammatory reaction of the capsule and/or synovium that subsequently leads to formation of adhesions in the axillary fold of attachment of inferior capsule to anatomic neck

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4
Q

how does adhesive capsulitis impacts the arthrokinemetics of the shoulder joint

A

stops humerus from rolling inferiorly like it normally does
- the inferior/anterior capsule isn’t lax like it is supposed to

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5
Q

what is frozen shoulder characterized by

A

functional restriction of both AROM and PROM shoulder motion

radiographs of GH joint unremarkable other than possible presence of:
- osteopenia
- calcific tendinitis

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6
Q

how can adhesive capsulitis be classified

A

primary - insidious onset, no significant event or associated condition

secondary - identifiable event or associated condition which led to it

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7
Q

what are 3 causes of secondary frozen shoulder

A

intrinsic - at or in the shoulder

extrinsic - identifiable abnormality remote to shoulder itself

systemic - associated w systemic disorders

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8
Q

what are intrinsic causes of secondary frozen shoulder (3)

A

rotator cuff disorders
biceps tendinitis
calcific tendinitis

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9
Q

what are extrinsic causes of secondary frozen shoulder (7)

A

mastectomy
heart surgery
cervical radiculopathy
CVA
MI
humeral fx
AC arthritis

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10
Q

what are systemic causes for secondary frozen shoulder (3)

A

DM
hyper/hypothyroidism
hypoadrenalism

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11
Q

what stage of a frozen shoulder is marked by pain

A

stage 2 - acute adhesive, freezing

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12
Q

what causes the pain experienced in stage 2 frozen shoulder? describe the pain

A

angry red synovitis is what causes pain

bad a rest, worse w movement
- causes an empty end feel (can’t move to point of restriction d/t pain)

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13
Q

what is an important component of pt education when it comes to frozen shoulder

A

telling them its a long road

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14
Q

what are the 2 biggest risks/causes of frozen shoulder

A

insidious
DM

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15
Q

why is DM a commonly associated risk factor w adhesive capsulitis

A

hyperglycemia leads to inc in intermolecular cross-linkages in collagen

collagen is more resistant to degeneration and more likely to accumulate

collagen cross-links may also inc the stiffness of connective tissue

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16
Q

describe the pathology of adhesive capsulitis (7 steps)

A
  1. chronic capsular inflammation
  2. capsular fibrosis
  3. constrictive capsulitis
  4. adhesion of synovial folds and axillary recess
  5. obliteration of joint cavity
  6. formation of scar tissue where adhesions are
  7. thickened and contracted capsule becomes fixed to bone
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17
Q

what would a capsular pattern present as

A

ER > ABD > IR

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18
Q

what is diagnostic criteria (4)

A

capsular pattern
insidious onset, night pain
painful & limited A-PROM
normal radiographs

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19
Q

what is the key indicator for diagnosing adhesive capsulitis

A

ALL motion is limited

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20
Q

how does a pt present (not including pain) - 3

A

insidious onset
difficulty sleeping
motion restriction continues

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21
Q

acute vs frozen/thawing stage primary presentation

A

acute - pain primary complaint

frozen/thawing - significant limitations in mobility

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22
Q

how does a pt’s pain typically present

A

pain predominant early
- new n. growth in capsuloligamentous complex
- vague in deltoid area
- C5 distribution along lateral arm

pain on palpation (bicipital groove)

pain at rest subsides w progression

pain resolves spontaneously

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23
Q

what are the two biggest things seen in a physical exam for someone in the acute stage

A

high reactivity
empty end feel

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24
Q

why is ROM restricted in sub-acute/chronic stages

A

scarred adhesions

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25
Q

how is joint play limited in sub-acute and chronic stages

A

limited throughout
- inferior most limited
- then anterior

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26
Q

what is the predominant feature noticed in a physical exam of sub-acute and chronic stages

A

motion restriction

27
Q

how do the end feels vary in early freezing vs frozen/thawing

A

early freezing - empty end feel
frozen/thawing - capsule/hard

28
Q

what stage would a pt likely be in if they complain they can’t sleep thru the night

A

acute freezing

29
Q

if someone is in the freezing stage, what is an important education piece to provide about their sx

A

its going to get worse before it gets better

30
Q

how are radiographs utilized in adhesive capsulitis

A

typically normal
can r/o other path

31
Q

what other path can radiographs r/o (5)

A

OA
osteoporosis
degenerative changes
calcium deposits
dec subacromial space

32
Q

what are 7 differential dx to consider if suspect adhesive capsulitis

A

impingement syndrome
rotator cuff lesion
biceps tendinitis
OA
cervical radiculopathy
neural tension
medical complications

33
Q

how can you differentiate between adhesive cap and impingement syndrome

A

impingement syndrome will have normal accessory glide at GH joint

34
Q

how can you differentiate between a RC lesion and adhesive cap

A

RC lesion will have normal PROM and accessory glide at GH joint

RC lesion will have pain w AROM w arm at side

35
Q

how can you differentiate between biceps tendinitis and adhesive cap

A

biceps tendinitis will have normal accessory glide at GH joint

36
Q

what differential dx is closely related to adhesive cap

A

biceps tendinitis
- pain is present w both dx

37
Q

how can you differentiate b/w OA and adhesive cap

A

OA will have (+) radiograph findings of spurring and dec joint space

38
Q

what similarities do you see between OA and adhesive cap

A

pain and capsular pattern

39
Q

how do you differentiate b/w cervical radiculopathy and adhesive cap

A

cervical radiculopathy will have sx reproducible w a cervical exam

40
Q

what similarities do you see in the presentation of cervical radiculopathy and adhesive cap

A

similar pain in C5 distribution

41
Q

how do you differentiate b/w neural tension and adhesive cap

A

neural tension is typically seen w trauma or repetitive stress

42
Q

what medical complications could be presenting similar to adhesive cap (5)

A

heart
lungs
spleen
gall bladder
thyroid

43
Q

how do you differentiate b/w adhesive cap and any other medical complications

A

medical complications will have an absence of mechanical findings

44
Q

what is an important component in optimizing treatment

A

depends on recognition of clinical stage at presentation
- condition will progress thru a predictable sequence

45
Q

what are the 4 overall goals of treatment

A

dec pain
dec inflammation
education - how long healing can take
restore capsular mobility

46
Q

use of modalities in treatment

A

lack of evidence for efficacy
- if anything might be helpful acutely
- but rarely in your tx plan

47
Q

what direction are mobilizations in typically

A

posterior and inferior
- people already leaning forward and putting pressure on anterior capsule

48
Q

why would mobilization of the posterior capsule be beneficial

A

posterior capsule restrictions prevent anterior movement of humeral head w ER

49
Q

what are some mobilization techniques that can be utilized in treatment

A

distraction
anterior
posterior
inferior
combined movements
- anterior and inferior
- posterior and inferior

50
Q

what patient would benefit to a combined motion of anterior-inferior mobilization

A

if pt has limited ER
- can add ER to take up slack

51
Q

what patient would benefit from a combined motion of posterior-inferior mobilization

A

if pt has limited IR
- can add IR to take up slack

52
Q

when is it ideal for interventions to be more aggressive

A

in frozen and thawing stages
- aggressive interventions would make condition worse in freezing stage

53
Q

what are benefits to a corticosteroid injection (3)

A

reduce pain and ms guarding
faster initial relief of sx
improved pain and ROM in initial 4wks

54
Q

what plays a role in the efficacy of a corticosteroid injection

A

the earlier the better
- more significant improvements in acute stage (2-6wks in studies)

studies showing no difference at 12wks

55
Q

what is the method to doing a manipulation under GA/brachial plexus block

A

short lever arm force into ABD while stabilizing scap followed by manip into ER and IR

56
Q

what are complications to performing a manipulation under GA/brachial plexus block (5)

A

fx: glenoid, scap, humeral
dislocation
RC/labral tear
hemarthrosis
brachial plexus traction injury

57
Q

who is a good candidate for a corticosteroid injection

A

high irritability cases

58
Q

what pathology is characteristic of stage 1

A

synovial inflammation
minimal or no loss of mobility

59
Q

what pathology is characteristic of stage 2

A

synovitis
early adhesions

60
Q

what pathology is characteristic of stage 3

A

loss of axillary fold
dec synovitis

61
Q

what pathology is characteristic of stage 4

A

mature adhesions and motion restriction
capsular end feel

62
Q

what is the role of PT post-op an arthroscopic capsular release

A

daily pt
- prevent scarring from coming back in

63
Q

where do you see the arthroscopic capsular release anatomically

A

typically RC interval and coracohumeral ligament

can release other shoulder ligaments and posterior capsule

MSK 1 (31 decks)

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