Adhesive Capsulitis

Question 1

Definition of what?
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 1

Adhesive Capsulitis.

Also referred to as “frozen shoulder”

Question 2

True/False

frozen shoulder is more common in younger populations

Answer 2

False

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

Question 3

Frozen shoulder is often associated with what diseases and conditions

Answer 3

Diabetes, thyroid disease, autoimmune disorders, stroke, Parkinsons, HIV medication use

Question 4

Frozen shoulder commonly described as going through three main phases of pain and injury:

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

Answer 4

(b) 2-9 Months
(2) 4 to 12
(3) Recovery phase

Question 5

Concern for adhesive capsulitis is raised when a patient with history of shoulder injury complains of what?

Answer 5

Severe pain that is worse at night

(a) “Nagging pain”

Question 6

Dx/Tx
Presentation
Issues with work or activities of daily living
(1) Varying degrees of impaired function
Often with history of shoulder injury and immobilization
Physical Examination
(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

Answer 6

Frozen Shoulder 
Treatment
(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 7

Referral Decisions

(a) Referral for patients not responding to conservative management
- -1) Sports medicine for injections of ______
- -2) Ortho for _____
- —a) Likely does not improve outcomes

Answer 7

1) steroid

2) surgery

Question 8

Diagnostic Tests

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

Answer 8

a) normal
b) MRI
c) Ultrasound