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Extremities Technique II > Adhesive Capsulitis (Frozen Shoulder) > Flashcards

Adhesive Capsulitis (Frozen Shoulder) Flashcards

1
Q

What is the chronic disorder of the glenohumeral joint capsule and synovial lining that involves inflammation followed by fibrosis?

A

Adhesive capsulitis

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2
Q

What is adhesive capsulitis?

A
  • Chronic disorder of glenohumeral joint capsule and synovial lining
  • An initial inflammatory process followed by reactive joint capsule fibrosis
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3
Q

What is the etiology of adhesive capsulitis?

A

Unknown

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4
Q

What is primary adhesive capsulitis?

A

Arises spontaneously and is not associated with or caused by a previous disease

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5
Q

If adhesive capsulitis is spontaneous and is not associated with or caused by a previous disease, it is ___

A

primary

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6
Q

What is secondary adhesive capsulitis?

A

Follows from an earlier disease

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7
Q

What types of disorders may lead to secondary adhesive capsulitis?

A
  • Systemic disorders
  • Shoulder disorders
  • Non-shoulder disorders
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8
Q

___% of diabetics develop frozen shoulder

A

10-36%

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9
Q

What systemic disorders may lead to secondary adhesive capsulitis?

A
  • Diabetes mellitus (type 1 and 2)
  • Thyroid disease (hyperthyroid and hypothyroid)
  • Autoimmune diseases
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10
Q

What shoulder disorders may lead to secondary adhesive capsulitis?

A
  • Rotator cuff disease
  • Prolonged shoulder immobilization
  • Shoulder trauma
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11
Q

What non-shoulder disorders may lead to secondary adhesive capsulitis?

A
  • Chest or breast surgery
  • Myocardial infarction
  • Non-shoulder surgery
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12
Q

How old is the typical patient with adhesive capsulitis?

A

Between 40 and 60 years of age

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13
Q

What are the three stages adhesive capsulitis?

A

Stage 1 (painful)
Stage 2 (frozen)
Stage 3 (thawing)

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14
Q

How long is the painful stage of adhesive capsulitis?

A

1-4 months

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15
Q

Which stage of adhesive capsulitis involves inflammation of synovial lining?

A

Stage 1 (painful)

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16
Q

If a patient complains of the following, which stage of adhesive capsulitis is likely?

  • Gradual onset of shoulder pain
  • Progressive worsening
  • Aggravated by activity
A

Stage 1 (painful)

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17
Q

Upon physical exam, a patient has mild loss of active and passive glenohumeral joint range of motion in various planes (in no pattern)
Which stage of adhesive capsulitis is likely?

A

Stage 1 (painful)

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18
Q

How long is the frozen stage of adhesive capsulitis?

A

lasts 3-9 months or longer

19
Q

In which stage of adhesive capsulitis frequently misdiagnosed?

A

Stage 1 (painful)

20
Q

Which stage of adhesive capsulitis involves joint capsule fibrosis and contracture?

A

Stage 2 (frozen)

21
Q

Which stage of adhesive capsulitis involves the joint capsule gradually remodeling and stretching?

A

Stage 3 (thawing)

22
Q

If a patient presents with the following, which stage of adhesive capsulitis is likely?

  • Shoulder stiffness
  • Decreasing pain
A

Stage 2 (frozen)

23
Q

If a patient presents with the following, which stage of adhesive capsulitis is likely?

  • Patients have decreasing stiffness
  • Minimal pain
A

Stage 3 (thawing)

24
Q

If a patient has the following results in a physical exam, what stage of adhesive capsulitis is likely?

  • Increasing loss of ROM
  • Most limited in external rotation (by 50% or more)
  • Capsular pattern may be present
A

Stage 2 (frozen)

25
Q

If a patient has the following results in a physical exam, what stage of adhesive capsulitis is likely?

  • Improving ROM often still most limited in external rotation
  • Capsular pattern may be present
A

Stage 3 (thawing)

26
Q

What is the capsular pattern that may be present in stages 2 and 3 of adhesive capulitis?

A
  • External rotation (greatest loss of motion)
  • Abduction
  • Internal rotation

(Loss of ER –> Abd –> IR)

27
Q

What imaging is normal for diagnosing adhesive capsulitis of the shoulder?

A

Radiographs/X-rays are normal
CT or MRI are not routinely necessary in the initial evaluation

28
Q

What would be the purpose of a CT or MRI scan looking for adhesive capsulitis of the shoulder?

A

May demonstrate inflammation and edema (especially in stage 1)
May demonstrate thickened joint capsule (especially in stages 2 and 3)

29
Q

Manual treatment of adhesive capsulitis learned in class is adapted from…

A

Souza (Differential Diagnosis and Management for the Chiropractor, 3rd edition)

30
Q

What are some manual treatments for stage 1 adhesive capsulitis of the shoulder?

A
  • Pain relief (transcutaneous electrical nerve stimulation (TENS))
  • Low grade mobilization (avoid aggressive mobilization or manipulation)
  • Codman’s (pendulum) exercise (can be done in combination with TENS)
31
Q

If the following are being performed as treatment, what stage of adhesive capsulitis is likely?

  • Pain relief (transcutaneous electrical nerve stimulation (TENS))
  • Low grade mobilization (avoid aggressive mobilization or manipulation)
  • Codman’s (pendulum) exercise (can be done in combination with TENS)
A

Stage 1 adhesive capsulitis

32
Q

What are some manual treatments for stage 2 and 3 adhesive capsulitis of the shoulder?

A
  • Heat (pretreatment)
  • Passive stretching (low load, long duration)
  • Mobilization
  • Manipulation
  • Ice/cold (posttreatment)
33
Q

How do the following treatments affect a shoulder with adhesive capsulitis?

Low grade mobilization:
High grade mobilization:
Manipulation:

A

Low grade mobilization: may be helpful
High grade mobilization: may be helpful but has increased risk of inflammatory flair-up
Manipulation: likely to cause an inflammatory flair-up

34
Q

If the following are being performed as treatment, what stage of adhesive capsulitis is likely?

  • Heat (pretreatment)
  • Passive stretching (low load, long duration)
  • Mobilization
  • Manipulation
  • Ice/cold (posttreatment)
A

Stage 2 or 3 adhesive capsulitis

35
Q

The chiropractor is most effective in stage(s) ___ of adhesive capsulitis of the shoulder

A

stages 2 and 3

36
Q

Mobilization methods are based on Vermeulen (Physical Therapy, 2006)
What type of study was conducted to obtain supporting data?

A

Randomized trial of 100 subjects with stage 2 adhesive capsulitis

37
Q

According to Vermeulen (Physical Therapy, 2006), stage 2 adhesive capsulitis should be treated with ___% low grade mobilization and ___% high grade mobilization

A

50% low grade
50% high grade

38
Q

According to Vermeulen (Physical Therapy, 2006), what directions should stage 2 adhesive capsulitis be mobilized?

A
  • A-P glide
  • P-A glide
  • S-I glide
  • Lateral distraction (M-L)
39
Q

What were the conclusions about adhesive capsulitis treatment drawn from the study in Vermeulen (Physical Therapy, 2006)?

A
  • All subjects improved significantly with both treatments
  • High grade mobilization was more effective than low grade mobilization (this difference was small)
40
Q

When should a chiropractor refer a patient to an orthopedist for adhesive capsulitis?

A
  • Pain control: severe pain or difficulty sleeping due to pain
  • Concern about other diagnoses (questionable X-ray)
  • No subjective or objective improvement after 6-8 weeks of treatment
41
Q

What are some medical managements for adhesive capsulitis?

A
  • NSAIDs
  • Corticosteroid injections (stage 1)
42
Q

Do most patients with adhesive capsulitis require surgical management?

A

No, most respond with non-surgical treatment

43
Q

If a patient has persistent stiffness and pain after 4-6 months of noninvasive treatment, what might be warranted?

A

Surgical management

44
Q

What are some methods of surgical management of adhesive capsulitis?

A
  • Manipulation under anesthesia
  • Capsular distension
  • Arthroscopic or open capsular release

Extremities Technique II (8 decks)

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