Adhesive Capsulitis Flashcards
What is adhesive capsulitis?
GHJ capsule becomes contracted and adherent to the humeral head.
This leads to shoulder pain + reduced range of movement.
Epidemiology of adhesive capsulitis
3% of pop
F > M
40-70 year olds
If you have been previously affected by adhesive capsulitis in your right shoulder, you are also more susceptible to it in your left.
Pathophysiology of adhesive capsulitis.
There primary (idiopathic) and secondary. Often associated with inflammatory diseases and currently theory suggest that autoimmune elements might be present as well.
There are three stages:
- *Initial painful stage**
- *Freezing stage**
- *Thawing stage**
Conditions causing secondary adhesive capsulitis.
Rotator cuff tendinopathy
Subacromial impingment syndrome
Biceps tendinopathy
Previous surgery or trauma
Known joint arthropathy
Clinical features of adhesive capsulitis.
Generalised deep and constant pain and can radiate to biceps.
Pain often disturbs sleep.
Joint stiffness and reduction in movement and function.
Findings on examination.
Loss of arm swing
Atrophy of deltoid
Generalised tenderness
Limited range of motion especially external rotation + flexion of shoulder.
Dx of adhesive capsulitis
Acromioclavicular pathology
Subacromial impingement syndrome
Muscular tear
Autoimmune disease (PMR, RA, SLE)
Ix of adhesive capsulitis
Diagnosis can be made clinically and is mostly done so.
X-ray (usually normal but done to rule out dx)
MRI (to confirm)
HbA1c and blood glucose (it is associated with DM)
MRI findings
Thickening of the GHJ capsule.
MRI can also be done to rule out other conditions like subacromial impingement syndrome.
Management principles
General and conservative
Surgical intervention
Explain the general and conservative management
It is a self-limiting condition but recurrence is common.
Recovery can usually take months to years.
Education and reassurance + physiotherapy.
Start management of pain with simple analgesics.
If pain fails to improve GHJ corticosteroid injections can be considered.
Surgical intervention
Indications are no improvement following prolonged engagement with full conservative management.
Joint manipulation under general anaesthetics.
This remove adhesions from capsule to humerus, arhtrogaphic distension or surgical release of the GHJ capsule.
Complications
Some patients never regain full range of motion
Symptoms may persist beyond two years and can occur in the contralateral shoulder as well.
