Adhesive capsulitis frozen shoulder

Question 1

Hx

Answer 1

57 yr old F 3 month hx R shoulder pain, not gotten worse, but hasn’t settled despite painkillers, intermittent and aching pain, hard to wash/dress/sleep
DM1, on insulin, well controlled

Question 2

look/ inspect

Answer 2

reduced muscle bulk r deltoid disuse atrophy

Question 3

feel

Answer 3

no tenderness over r glenohumeral joint

Question 4

active movement

Answer 4

reduced and painful ROM [ particularly lateral rotation followed by abduction followed by medial rotation]

Question 5

passive movement

Answer 5

reduced and painful ROM [particularly lateral rotation followed by abduction followed by medial rotation]
resistant and painful end feel but no crepitus

Question 6

DDx

Answer 6

adhesive capsulitis
rotator cuff pathology
gleno-humeral arthritis

Question 7

why is adhesive capsulitis likely?

Answer 7

hx painful and stiff shoulder, hx of diabetes

exam reduced and painful active and passive ROM, no tenderness

Question 8

why is rotator cuff pathology unlikely?

Answer 8

no tenderness
limited range of passive motion
no painful arc during active ROM
no pain on resisted movement

Question 9

why is gleno-humeral osteoathritis unlikely?

Answer 9

slower onset of OA
not as painful at beginning
tenderness present also

Question 10

GP investigations

Answer 10

X-ray shoulder for OA, calcific tendinitis
Bloods for FBC, ESR, CRP, rheumatoid screen
MRI rule out rotator cuff pathology

Question 11

Ortho innvestigations

Answer 11

MR arthrogram

loss of axillary recess indicates contracture of joint capsule

Question 12

Non-op tx

Answer 12

analgesia
physio
intra-articular steroids/LA
Refer to ortho

Question 13

op tx

Answer 13

MUA

Arthroscopic release