Adhesive Capsulitis

Question 1

What can be defined as “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 (“Frozen Shoulder”)

Question 2

Adhesive capsulitis is seen most commonly in patients __-__ years old

Answer 2

45-60

Question 3

Is adhesive capsulitis more common in men or women?

Answer 3

Women, especially perimenopausal

Question 4

Adhesive capsulitis is a self-_____ disease

Answer 4

limiting

Question 5

What is adhesive capsulitis caused by?

Answer 5

acute inflammation of the capsule followed by scarring and remodeling

Question 6

Frozen shoulder is often associated with what other diseases and conditions?

Answer 6

Endocrine disorders such as diabetes mellitus and thyroid disease

Question 7

Frozen shoulder is also common following what 5 things?

Answer 7

• prolonged immobilization
• stroke
• autoimmune disease
• Parkinson disease (rare)
• antiretroviral therapy for HIV infection (rare)

Question 8

Frozen shoulder is also considered a secondary problem that develops after shoulder injuries such as what?

Answer 8

• rotator cuff tears
• proximal humerus fractures
• shoulder surgery
• cardiac surgery
• neurosurgery

Question 9

What are the signs and symptoms associated with adhesive capsulitis?

Answer 9

• Very painful shoulder triggered by minimal or no trauma
• Pain out of proportion to clinical findings during the inflammatory phase
• Painful shoulder with limited ROM with both passive and active movements
• Limitation of external rotation

Question 10

What are the 3 phases of adhesive capsulitis?

Answer 10

• inflammatory phase
• freezing phase
• thawing phase

Question 11

The inflammatory phase usually last how long?

Answer 11

4-6 months

Question 12

What does the patient complain of during the inflammatory phase?

Answer 12

A very painful shoulder without obvious clinical findings to trauma, fracture, or RC tear.

Question 13

The freezing phase usually last how long?

Answer 13

4-6 months (from month 8 to month 12)

Question 14

What does the patient complain of during the freezing phase?

Answer 14

The shoulder becomes stiffer and stiffer even though the pain is improving

Question 15

The thawing phase usually last how long?

Answer 15

up to 1 year

Question 16

What does the patient complain of during the thawing phase?

Answer 16

The shoulder begins to regain ROM

Question 17

The total duration of an idiopathic frozen shoulder is usually about how long?

Answer 17

2 years

Question 18

Why is imaging necessary?

Answer 18

To rule out GH arthritis

Question 19

What do MRI findings typically show?

Answer 19

a thickening of the joint capsule and the coracohumeral ligament

Question 20

Typically, how is adhesive capsulitis diagnosed?

Answer 20

clinically

Question 21

What treatment regimen is recommended during the freezing phase of adhesive capsulitis?

Answer 21

• NSAIDS
• Physical therapy
• Intra-articular corticosteroid injection or oral prednisone

Question 22

Are anti-inflammatory medications helpful during the thawing phase?

Answer 22

No, symptoms resolve with time

Question 23

What are 2 surgical treatment options for those with adhesive capsulitis?

Answer 23

• Manipulation under anesthesia

- Arthroscopic release

Question 24

When should you refer a patient to surgery?

Answer 24

When they do not respond after more than 6 months of conservative treatment.

OR

When there is no progress or worsening range of motion over 3 months.