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OCS Cards > Adhesive Capsulitis CPG > Flashcards

Adhesive Capsulitis CPG Flashcards

1
Q

Does frozen shoulder affect DM type I or II?

A

Both - no discrimination between the two

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2
Q

What part of the capsuloligamentous complex may be most implicated in loss of ROM?

A

Proximal portion (superior, middle GH ligaments)

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3
Q

What part of the capsuloligamentous complex makes up the RTC interval?

A

Superior GH joint ligament, coracohumeral ligament

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4
Q

With the arm in 45 deg of abduction, what restricts ER with adhesive capsulitis greatest?

A

Proximal portion of capsule + subscapularis muscle

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5
Q

What limits ER the most at 0 deg of abduction or neutral adduction?

A

Subscapularis

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6
Q

When there is a greater loss of ER at 45 degrees of abduction versus 90 degrees of abduction, what is liable?

A

Subscapularis

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7
Q

Why does there tend to be a heightened pain response with adhesive capsulitis?

A

New nerve growth, angiogenesis

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8
Q

What causes the sustained, intense inflammatory/fibrotic response of the joint capsule?

A

Elevated cytokine levels

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9
Q

Do those diagnosed with adhesive capsulitis due to DM have an easier or longer recovery?

A

Tends to be protracted with worse outcomes, sxs for years

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10
Q

In terms of relative risk ratio, do men or women have higher risk with thyroid disease?

A

Women at 7.3 (men at 2.6)

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11
Q

In terms of relative risk ratio, do men or women have higher risk with DM?

A

Fairly equal, men 5.9 - women 5.0

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12
Q

What is the typical age of onset for adhesive capsulitis?

A

41-65 y.o (highest at 51-55)

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13
Q

What are 3 clinical/subjective ‘signs’ of adhesive capsulitis?

A

Reports of sleep disturbance
Report of inability to sleep on affected side
Restriction in ROM

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14
Q

If ROM tends to decrease during course of treatment, what is the likely outcome for the patient?

A

Surgical intervention

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15
Q

What stage is the first 3 months where the patient experiences sharp pain at end range, achy pain at rest and sleep disturbance?

A

Stage 1

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16
Q

What are cardinal signs of stage 1 of adhesive capsulitis?

A

1) sleep disturbance
2) sharp pain at end range
3) achy pain at rest

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17
Q

During stage 1, what is the hallmark sign for adhesive capsulitis?

A

Intact RTC with loss of ER

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18
Q

What stage is months 3-9, where there is painful gradual loss of ROM in all direction?

A

Stage 2

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19
Q

What are cardinal signs of stage 2 of adhesive capsulitis?

A

1) gradual loss of ROM in all directions
2) angiogenesis under arthorscopy
3) painful ROM

20
Q

What stage is months 9-15 months, with a consistent loss of ROM with pain?

A

Stage 3

21
Q

What stage is months 15-24 months with resolving pain and remaining stiffness?

A

Stage 4

22
Q

Define primary/idiopathic adhesive capsulitis:

A

Not associated with systemic condition or hx of injury

23
Q

Secondary adhesive capsulitis is related to disease/pathology and has three subcategories: what are they?

A

Systemic (DM, thyroid)
Extrinsic (CVA, MI, COPD)
Intrinsic (RTC/biceps tendinopathy, calcific tendonitis, proximal humeral/ scapular fx)

24
Q

What is the clinical definition of adhesive capsulitis?

A

ROM loss of > 25% in at least 2 planes, PROM ER loss of > 50% or less than 30 deg (compared to uninvolved)

25
Q

What is the Cyriax capsular pattern for adhesive capsulitis?

A

ER loss > abduction > IR loss - not consistent though

26
Q

What are characteristics of high irritability level patients with adhesive capsulitis?

A

High pain levels, high disability, constant resting/night pain, pain before end range, more PROM than AROM

27
Q

What are characteristics of moderate irritability level patients with adhesive capsulitis?

A

Pain in 4-6/10 range, intermittent rest/night pain, moderate disability, pain at end range, AROM similar to PROM

28
Q

What are characteristics of low irritability level patients with adhesive capsulitis?

A

Pain < 3/10, no night or rest pain, minimal disability, pain with overpressure at end range, AROM = PROM

29
Q

What are interventions for high irritability level patients?

A

1) modalities (heat, stim)
2) pt education - management, activity modification
3) low intensity GH mobs
4) pain free PROM/AAROM

30
Q

What are interventions for moderate irritability level patients?

A

1) modalities PRN
2) pt education - progressing activities/function without irritation
3) moderate intensity GH mobs into resistance
4) scapulohumeral rhythm with reaching

31
Q

What are interventions for low irritability level patients?

A

1) pt education - progressing to high demand, recreational activities
2) end range joint mobs - high amplitude, long duration
3) continue to focus on ST/GH joints rhythm

32
Q

How can one diagnose adhesive capsulitis via radiograph?

A

Looking at joint capsule capacity, less than 10-12 mL - variable filling of axillary and subscapular recess

33
Q

What MRI findings are consistent with adhesive capsulitis?

A

Thickened coracohumeral ligament, thickened joint capsule in RTC interval

34
Q

In a recent study by Homsi, what diagnostic tool was used to identify a thickened coracohumeral ligament consistent with adhesive capsulitis?

A

Ultrasound - found thickness of 3 mm

35
Q

What is the MCID / MDC of the American Shoulder and Elbow Surgeons outcome measure (ASES)?

A

MCID - 6.4

MDC - 9

36
Q

What is the MCID /MDC of the Shoulder pain and disability index (SPADI)?

A

MCID - 8-13

MDC - 17-19

37
Q

Which outcome measure has better responsiveness, DASH or SPADI?

A

SPADI

38
Q

What is the MCID/ MDC of the Disabilities of the Arm, Shoulder and Hand (DASH)?

A

MCID - 10.2

MDC - 10.5

39
Q

Is success with intervention purely based on ROM?

A

No, more on reduced pain, improved function, patient satisfaction

40
Q

Strong evidence suggests corticosteroid injections are more effective in the short or long term for adhesive capsulitis?

A

In the short term - coupled with motion/stretching exercise

Grade A evidence

41
Q

Moderate evidence suggests focusing pt education on two facets of adhesive capsulitis. Those facets being:

A

1) natural course of the disease

2) activity modification for functional, pain free ROM with matched intervention intensity

42
Q

What type of evidence exists with use of modalities with adhesive capsulitis?

A

Weak evidence - ultrasound, shortwave diathermy, electrical stimulation

43
Q

What type of evidence currently exists for GH joint mobilizations for adhesive capsulitis?

A

Weak evidence - poor match of intervention to irritability level, no evidence to support manual therapy has superior efficacy over other interventions

44
Q

In a randomized perspective study, were there benefits to higher grade joint mobilizations versus lower grade joint mobilizations?

A

Moderate evidence for lower grade mobilizations are just as effective

45
Q

What type of evidence exists for stretching and it as an intervention matched to irritability level?

A

Moderate evidence - influences pain, improves ROM, but not necessarily more than other interventions

OCS Cards (23 decks)

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