Adhesive Capsulitis (Frozen Shoulder) Flashcards
Definition and Classification
> Formation of excessive scar tissue + adhesions across glenohumeral joint (ligaments + capsule are affected)
Characterised by stiffness, pain and dysfunction
Primary = Idiopathic (spontaneous)
Secondary = Post trauma (fall/fracture/surgery)
Risk Factors
> Female (although men respond less well to treatment)
40 + years
Trauma
Diabetes (+worse outcomes)
hyperthyroidism
Cerebrovascular attack or coronary artery disease
Positive HLA-B27 test (shows higher chance of autoimmune disorders)
link to dupuytren’s
Stages
- Shoulder pain (especially at night)
- Synovitis without adhesions (visible on arthroscopy)
- Inflammatory cells infiltrate the synovium - Stiffness develops (still painful)
- Synovitis
- Some loss of axillary fold (early adhesions + capsular contracture)
- Synovial proliferation (cells reproduce rapidly - more dense fibrous tissue in capsule) - Global loss of RoM (pain at ends of range)
- Synovitis = resolved
- Significant adhesions (axillary fold has gone)
- Dense collagenous tissue in capsule - Chronic Stiffness (minimal pain)
- Synovitis is resolved
- Advanced adhesions (RoM may improve due to pain reduction )
Clinical presentation
> 1st = pain
2nd = gradual loss of RoM (both active + passive)
- lateral rotation is usually first affected then global loss
Firm, painful end feel to passive movement
Diagnosis
Imaging is not necessary but can be used to rule out other conditions such as pancoast tumour (cancer in apex of lungs)
Management
> Physio
- Early mobilisation (so pain regulation is key)
- education
NSAIDs
Corticosteroid injection
Hydrodilation (pump full of water to stretch + tear adhesions)
Surgery
- Manipulation under anaesthetic
- Capsular release (debridement of capsule - particularly coracohumeral lig, contracted capsule, rotator interval)
*Recurrence rate of 11% post surgery
