Adhesive Capsulitis (Frozen Shoulder) Flashcards
What is the chronic disorder of the glenohumeral joint capsule and synovial lining that involves inflammation followed by fibrosis?
Adhesive capsulitis
What is adhesive capsulitis?
- Chronic disorder of glenohumeral joint capsule and synovial lining
- An initial inflammatory process followed by reactive joint capsule fibrosis
What is the etiology of adhesive capsulitis?
Unknown
What is primary adhesive capsulitis?
Arises spontaneously and is not associated with or caused by a previous disease
If adhesive capsulitis is spontaneous and is not associated with or caused by a previous disease, it is ___
primary
What is secondary adhesive capsulitis?
Follows from an earlier disease
What types of disorders may lead to secondary adhesive capsulitis?
- Systemic disorders
- Shoulder disorders
- Non-shoulder disorders
___% of diabetics develop frozen shoulder
10-36%
What systemic disorders may lead to secondary adhesive capsulitis?
- Diabetes mellitus (type 1 and 2)
- Thyroid disease (hyperthyroid and hypothyroid)
- Autoimmune diseases
What shoulder disorders may lead to secondary adhesive capsulitis?
- Rotator cuff disease
- Prolonged shoulder immobilization
- Shoulder trauma
What non-shoulder disorders may lead to secondary adhesive capsulitis?
- Chest or breast surgery
- Myocardial infarction
- Non-shoulder surgery
How old is the typical patient with adhesive capsulitis?
Between 40 and 60 years of age
What are the three stages adhesive capsulitis?
Stage 1 (painful)
Stage 2 (frozen)
Stage 3 (thawing)
How long is the painful stage of adhesive capsulitis?
1-4 months
Which stage of adhesive capsulitis involves inflammation of synovial lining?
Stage 1 (painful)
If a patient complains of the following, which stage of adhesive capsulitis is likely?
- Gradual onset of shoulder pain
- Progressive worsening
- Aggravated by activity
Stage 1 (painful)
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?
Stage 1 (painful)
How long is the frozen stage of adhesive capsulitis?
lasts 3-9 months or longer
In which stage of adhesive capsulitis frequently misdiagnosed?
Stage 1 (painful)
Which stage of adhesive capsulitis involves joint capsule fibrosis and contracture?
Stage 2 (frozen)
Which stage of adhesive capsulitis involves the joint capsule gradually remodeling and stretching?
Stage 3 (thawing)
If a patient presents with the following, which stage of adhesive capsulitis is likely?
- Shoulder stiffness
- Decreasing pain
Stage 2 (frozen)
If a patient presents with the following, which stage of adhesive capsulitis is likely?
- Patients have decreasing stiffness
- Minimal pain
Stage 3 (thawing)
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
Stage 2 (frozen)
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
Stage 3 (thawing)
What is the capsular pattern that may be present in stages 2 and 3 of adhesive capulitis?
- External rotation (greatest loss of motion)
- Abduction
- Internal rotation
(Loss of ER –> Abd –> IR)
What imaging is normal for diagnosing adhesive capsulitis of the shoulder?
Radiographs/X-rays are normal
CT or MRI are not routinely necessary in the initial evaluation
What would be the purpose of a CT or MRI scan looking for adhesive capsulitis of the shoulder?
May demonstrate inflammation and edema (especially in stage 1)
May demonstrate thickened joint capsule (especially in stages 2 and 3)
Manual treatment of adhesive capsulitis learned in class is adapted from…
Souza (Differential Diagnosis and Management for the Chiropractor, 3rd edition)
What are some manual treatments for stage 1 adhesive capsulitis of the shoulder?
- 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)
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)
Stage 1 adhesive capsulitis
What are some manual treatments for stage 2 and 3 adhesive capsulitis of the shoulder?
- Heat (pretreatment)
- Passive stretching (low load, long duration)
- Mobilization
- Manipulation
- Ice/cold (posttreatment)
How do the following treatments affect a shoulder with adhesive capsulitis?
Low grade mobilization:
High grade mobilization:
Manipulation:
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
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)
Stage 2 or 3 adhesive capsulitis
The chiropractor is most effective in stage(s) ___ of adhesive capsulitis of the shoulder
stages 2 and 3
Mobilization methods are based on Vermeulen (Physical Therapy, 2006)
What type of study was conducted to obtain supporting data?
Randomized trial of 100 subjects with stage 2 adhesive capsulitis
According to Vermeulen (Physical Therapy, 2006), stage 2 adhesive capsulitis should be treated with ___% low grade mobilization and ___% high grade mobilization
50% low grade
50% high grade
According to Vermeulen (Physical Therapy, 2006), what directions should stage 2 adhesive capsulitis be mobilized?
- A-P glide
- P-A glide
- S-I glide
- Lateral distraction (M-L)
What were the conclusions about adhesive capsulitis treatment drawn from the study in Vermeulen (Physical Therapy, 2006)?
- All subjects improved significantly with both treatments
- High grade mobilization was more effective than low grade mobilization (this difference was small)
When should a chiropractor refer a patient to an orthopedist for adhesive capsulitis?
- 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
What are some medical managements for adhesive capsulitis?
- NSAIDs
- Corticosteroid injections (stage 1)
Do most patients with adhesive capsulitis require surgical management?
No, most respond with non-surgical treatment
If a patient has persistent stiffness and pain after 4-6 months of noninvasive treatment, what might be warranted?
Surgical management
What are some methods of surgical management of adhesive capsulitis?
- Manipulation under anesthesia
- Capsular distension
- Arthroscopic or open capsular release
