Adhesive capsulitis Flashcards
Adhesive capsulitis
Glenohumeral joint capsule infammation
Classification of frozen shoulder
Primary - idiopathic
Secondary – associated with:
- rotator cuff tendinopathy
- subacromial impingement syndrome
- biceps tendinopathy
- previous surgery or trauma
- known joint arthropathy
Clinical features of frozen shoulder
- Progressive decline in active and passive ROM
- Generalised deep and constant pain of the shoulder (which may radiate to the bicep) - chronic
- Often worse at night and disturbs sleep.
- Joint stiffness and a reduction in function.
On examination:
- loss of arm swing
- atrophy of the deltoid muscle
- Generalised tenderness on palpation
- limited external rotation, abduction less than 90 and flexion of the shoulder
Ix of frozen shoulder
Mainly clinical
Xray - unremarkable
MRI - thickening of the glenohumeral joint capsule
Mx of frozen shoulder
Self limiting
- Stay active
- Ice
- Physio
Takes months to years to recover and may reoccur
Glenohumeral joint corticosteroid injections if failing to improve
Surgical:
If conservative fails - joint manipulation under general anaesthetic to remove capsular adhesions
Which endocrine disorder is most associated with adhesive capsulitis?
DM
Subacromial impingement syndrome
inflammation and irritation of the rotator cuff tendons as they pass through the subacromial space
Presentation of impingement syndrome
Pain, weakness, and reduced range of motion within the shoulder.
- Painful arc: 60-120 degrees
- Weakness and ↓ ROM
- +ve Hawkin’s test
- Pain at night especially when lying on the affected arm
Causes of impingement syndrome
Rotator cuff tendinosis
Subacromial bursitis
Calcific tendinitis
Intrinsic:
- overuse - microtears
- degeneration
- weakness of rotator cuffs causes imbalance
Extrinsic:
- congenital abnormality
- weak serratus anterior and trapezius
- glenohumeral instability - subluxation
Who commonly gets impingement syndrome
Patients under 25 years old
Typically in active individuals or in manual professions
Coracoacromial arch
Acromion
Coracoacromial ligament
Coracoid process
Subacromial space contents
Rotator cuff tendons
Long head of biceps tendon
Coraco-acromial ligament
Surrounded by the subacromial bursa which helps to reduce friction between these structures.
Special tests for impingement syndrome
Neers Impingement test – The arm is placed by the patient’s side, fully internally rotated and then passively flexed, and is positive if there is pain in the anterolateral aspect of the shoulder.
Hawkins test (scraf)– The shoulder and elbow are flexed to 90 degrees, with the examiner then stabilising the humerus and passively internally rotates the arm, and the test is positive if pain is in the anterolateral aspect of the shoulder.
Ix of impingement syndrome
Clinical - can be confirmed with MRI
- Plain radiographs: may see bony spurs - calcific tendonitis
- USS
- MRI arthrogram
Mx of impingement syndrome
Conservative:
- analgesia - NSAIDS
- physiotherapy
- rest
Medical: corticosteroid injections
Surgical:
- Repair of muscular tears
- Removal of the subacromial bursa (bursectomy)
- Removal of a section of the acromion - acriomioplasty
- Arthroscopic acromioplasty
