Adhesive Capsulitis

Question 1

Red flags for shoulder pain in primary care

Answer 1

Question 2

Proceeding events/problems that can result in frozen shoulder

Answer 2

• Rotator cuff disease - tendinopathy/impingement
• Trauma/previous surgery
• Prolonged immbolisation
• Known joint arthropathy

Question 3

Co-morbidities associated with adhesive capsulitis

Answer 3

• AI disease
• Diabetes
• Thyroid dysfunction
• Hyperlipidaemia
• Decreased mobility - Parkinsons, cardiac problems

Question 4

What happens in adhesive capsulitis?

Answer 4

• Glenohumeral joint capsule becomes contracted and adherent to humeral head
• = shoulder pain and reduced ROM

Question 5

Pathophys of adhesive capsulitis

Answer 5

• Primary - idiopathic
• Secondary - causes mentioned in previous card

Question 6

Presentation of adhesive capsulitis

Answer 6

• Deep and constant pain
• Disturbs sleep
• May radiate to bicep
• Loss of arm swing
• Atrophy of deltoid muscle
• Generalised tenderness
• Limited ROM - primarily affects external rotation and flexion
• Active and passive movements affected

Question 7

Differentials for shoulder pain

Answer 7

• Frozen shoulder
• Acromioclavicular pathology - joint injury, arthiritis
• Subacromial impingement syndrome - painful arc, preserved passive movements, history of overuse
• Muscular tear - weakness perists when shoulder pain relieved
• AI disease eg polymyalgia rheumatica - polyarthropathy and systemic symptoms

Question 8

Investigations for frozen shoulder

Answer 8

• Plain x-rays - rule out acromioclavicular pathology or atypical #
• MRI - thickening of glenohumeral joint capsule, also rules out subacromial impingement syndrome

Question 9

Bloods for AC

Answer 9

• HbA1C - associated with diabetes

Question 10

Management AC

Answer 10

• Recovery takes months to years
• Some patients never recover full ROM
• Physiotherapy
• Manage pain - WHO
• Glenohumeral joint corticosteroid injections
• Surgery if none of this works

Question 11

Surgery options AC

Answer 11

• Joint manipulation with GA to remove capsular adhesions
• Arthrographic distension - fluid into joint space, break up adhesions
• Surgical release of glenohumeral joint capsule

Question 12

Complications of AC

Answer 12

• Never regain full ROM
• Recurrence in contralateral shoulder

Question 13

3 phases of AC

Answer 13

• Freezing - 6-9 weeks - slow pain and stiffness
• Frozen - 4-6months - reducing pain, stiffness remains
• Thawing - 6months - 2yrs - regain ROM slowly

Question 14

Management options list for AC

Answer 14

• Physio
• NSAIDs
• Oral corticosteroids
• Intra-articular steroids
• Surgery

Question 15

Complications of intra-articular steroid injections

Answer 15

• Septic arthiritis
• Skin atrophy and hypopigmentation
• Post-injection flare - pain increases
• Infection
• Tendon/ligament rupture