Adhesive capsulitis/ACJ OA

Question 1

What is the presentation of adhesive capsulitis/frozen shoulder?

Answer 1

A progressive decrease in ROM (Active and passive)
Loss of external rotation
Shoulder pain - worse at night and lying on shoulder

Question 2

What causes adhesive capsulitis?

Answer 2

Unknown - suggested follows trauma especially in elderly

High association with DM, hypothyroidism, traums, cardiac/lipid problems

Question 3

What is the management of adhesive capsulitis?

Answer 3

Conservative - Rest, physio

Medical - NSAIDs, Subacromial bursa steroid/LA injection

Question 4

What is the pathology of adhesive capsulitis?

Answer 4

Shoulder capsule around glenohumeral joint becomes inflammed/stiff due to adhesions
Unknown cause

Question 5

What is Rotator Cuff Tear Arthropathy?

Answer 5

OA develops after a large chronic rotator cuff tendon tear. Torn rotator cuff can no longer hold humerus in place so rubs against the acromion causing degeneration

Question 6

What are 3 stages of Adhesive capsulitis/frozen shoulder?

Answer 6

1. Freezing stage - Associated with pain for around 3 months
2. Frozen stage - Pain at extreme range of movement and marked stiffness for around 3-9 months
3. Thawing stage - painless and the stiffness starts to gradual resolve at this stage. Usually lasts for 9-18 months

Question 7

How does AC OA present?

Answer 7

Painful shoulder
Stiff
May have some swelling
Common in middle age

Question 8

What can predispose the AC joint to OA?

Answer 8

Previous injury/trauma
Increasing age due to wear/tear
A job that involved a lot of overhead lifting
Athletes in contact sport
*Bony spurs develop*

Question 9

What are some of the treatments for ACJ OA?

Answer 9

Physiotherapy
NSAIDs
Steroid/LA injections into the joint
Surgery - ACJ excision