ADHESIVE CAPSULITIS

Question 1

Another name for adhesive capsulitis

Answer 1

“frozen shoulder”

Question 2

“A condition of varying severity characterized by the gradual development of
global limitation of active and passive shoulder motion where radiographic
findings other than osteopenia are absent.”

Answer 2

Adhesive Capsulitis.

Question 3

Who experiences adhesive capsulitis most

Answer 3

More common in older populations (50’s-60’s)

Question 4

any associated conditions with adhesive capsulitis

Answer 4

(4) Often associated with other diseases and conditions
(a) Diabetes, thyroid disease, autoimmune disorders, stroke, Parkinsons, HIV
medication use

Question 5

For AD members, when is someone most likely encounter adhesive capsulitis

Answer 5

Very commonly occurs after shoulder injuries.

Question 6

three main phases of pain and injury for patients with adhesive capsulitis

Answer 6

(1) Diffuse, severe, and disabling shoulder pain
(a) Increasing stiffness
(b) Last 2-9 months
(2) Stiffness and severe loss of shoulder motion with pain less pronounced
(a) Lasts for 4 to 12 months
(3) Recovery phase with stiffness and gradual return of shoulder motion that takes
about 5-24 months to complete

Question 7

When should we be concerned for adhesive capsulitis

Answer 7

complains of:

(1) Severe pain that is worse at night
(a) “Nagging pain”

Question 8

Physical Examination of a patient with Adhesive Capsulitis

Answer 8

(1) Visual
(a) Shoulder will appear normal on inspection typically
(b) Possible atrophy secondary to limited use of shoulder
(2) Strength
(a) 4-5/5
(3) ROM
(a) ROM reduction is likely most significant finding.
(b) Significant reduction in both passive and active ROM in two or more planes.
(4) External rotation and abduction most affected
(5) Neurovascular status
(a) Neurovascular intact
(6) Palpation
(a) Varying degrees of tenderness
(7) Special tests
(a) No specific manipulative maneuvers

Question 9

Diagnostic Tests of a patient with Adhesive Capsulitis

Answer 9

(a) Plain films most often normal
1) Regardless, reasonable to exclude other etiologies
(b) MRI for more challenging cases
1) Not necessary to make diagnosis
2) Often shows thickening of joint capsule
(c) Ultrasound also useful in diagnosing the dynamic changes that occur in the shoulder

Question 10

Treatment of a patient with Adhesive Capsulitis

Answer 10

(a) Evidence lacking in treatment
(b) Early mobilization for those with shoulder injuries
1) Avoid slings when possible
(c) Shoulder motion exercises
1) Physical therapy consult
(d) NSAIDs
(e) Tylenol
(f) Consider referral for steroid injection

Question 11

Referral Decisions of a patient with Adhesive Capsulitis

Answer 11

(a) Referral for patients not responding to conservative management
1) Sports medicine for injections of steroid
2) Ortho for surgery
a) Likely does not improve outcomes