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clinical practice guidelines > CPG Adhesive cap > Flashcards

CPG Adhesive cap Flashcards

1
Q

What is the hallmark clinical finding of adhesive capsulitis

A

lass of passive ROM, particularly ER with arm at the side and varying degrees of shoulder abduction
- theoretical evidence

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2
Q

what are the risk factors associated with Acap

A

DM (men and women) and hypoThyroid disease (women), h/o duputren’s disease
- moderate evidence

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3
Q

Acap is most prevalent in what populations

A

females general population, DM male (33%, females 26%), age 45-65 (peak 51-55), with history of contralateral Acap
- Moderate evidence

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4
Q

How long does Acap typical take to resoluve

A

12-18 months

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5
Q

what disability indexes have been validated for Acap

A
  1. DASH
  2. Shoulder and elbow surgeons shoulder sale (ASES)
  3. Shoulder pain and disability index (SPADI)
    - Strong evidence
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6
Q

Describe the role of corticosteroid injections in Acap

A

when combined with mobility and stretching exercises it is effective in providing short term pain relief (4-6 weeks) compared to exercise alone
- strong evidence

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7
Q

What are the educational recommendations for Acap

A
  1. understand the natural course of the disease
  2. promote activity modification to encourage functional pain free motion
  3. match intensity of stretching to patient current level of irritability
    - moderate evidence
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8
Q

what modalities are recommend for Acap

A

Week evidence suggests short wave diathermy, US and estim when combined with stretching and joint mobs can help control symptoms

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9
Q

What forms of treatment are recommend for Acap

A
  • joint mobs weak evidence
  • manipulation under anesthesia weak evidence
  • stretching matched to stage of irritability moderate evidence
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10
Q

how does the prevalence of shoulder pain compare to the prevalence of Acap in the general population

A

shoulder pain 2.4-26%

ACap 2-5.3%

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11
Q

Subscapularis will restrict what motins

A

ER at 0

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12
Q

Cadaver sides of Acap demonstrates what pathoanatomic features

A

Limitations of the proximal portions of the capsuloligamentous complex and subscap tendon

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13
Q

what is rotator cuff interval

A
  • triangular shaped tissue bridge between the anterior supraspinatus, upper subscapularis, upper biceps sulcus lateral ridge at the transverse humeral ligament
  • composed of the superior GH lig and coracohumeral ligament
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14
Q

what is the pathoanatomic origin of Acap

A

there is some debate with level IV data
- synovitis
- agniogeneisis with nerve in growth
This develops into capsiloligamentus fibrosis can contracture
- primarily involves rotator cuff interval, but can be the entire capsule

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15
Q

What causes Acap

A

unkown

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16
Q

Level IV evidence also suggest what risk factors

A
  • prolonged immobilization
  • MI
  • trauma
  • autoimmune disease
17
Q

describe the clinical course of Acap

A

4 stages

  1. up to 3 months - sharp end range pain, ache at rest and difficulty sleeping. marked synovial irritation without contracture
  2. 3-9 months - gradual loss of motion - aggressive synovitis with some ROM loss under anesthesia
  3. 9-15 months - reduction of synovitis and resultant fibrosis
  4. 15-24 months - pain reaction with gradual return of ROM
18
Q

What are the MSK clinical signs typically used to identify Acap

A
  • shoulder pain longer than on e month
  • sleep disturbance due to shoulder pain
  • inability to lie on the affected side
  • restricted in all AROM and PROM
  • 50% reduction in ER and 25% reduction in at least 2 planes
19
Q

what factors are predictive of Manipulation for Acap

A
  • prior rehab
  • work comp claim
  • pending litigation
20
Q

How does the course of recovery differ for function and pain with Acap

A
  • Function and satisfaction tend to have full resolution

- pain and ROM loss can last much longer and does not follow the same recovery pattern as functional return

21
Q

what is the difference between primary and secondary Acap

A
  1. primary has no associated health conditions

2. secondary is linked to a disease or pathology

22
Q

what are the subcategories of secondary Acap

A
  1. systemic
  2. extrinsic
  3. intrinsic
23
Q

what are the conditions associated with systemic secondary Acap

A
  1. DM

2. thyroid disease

24
Q

what are the conditions associated with extrinsic secondary Acap

A
  1. CVA
  2. intrathoracic conditions such as MI or COPD
  3. intra-abdominal conditions
  4. cerivcal disc disease
  5. distal extremity fractures
  6. self imposed immobilization
25
Q

what conditions are associated with intrinsic secondary Acap

A

things within the GH

  1. RTC and bicep tendonopathies
  2. AC and GH arthropathies
  3. proximal humeral or scapular fractures
26
Q

describe the data surround cyriax capsular pattern

A
  • Capsular pattern of ascending loss of ER, abd, IR

- Data shows there is a loss of ER at the side, abduction and IR greater than ER with arm abducted

27
Q

what the the Acap clinical practice guidelines

A
  1. component 1 - Medical screening to determine if the person is appropriate for physical therapy
  2. component 2 - differential evaluation for MSK impairment of body function (ICF) and associated tissue pathology (ICD)
  3. component 3: diagnosis of tissue irritability level
  4. component 4: interventional strategies
28
Q

What diagnostic classifications are suggested for the shoulder

A
  1. shoulder pain and mobility deficits/Acap
  2. shoulder stability and movement coordination impairments (dislocation, sprain strain)
  3. shoulder pain and muscle power deficits and RTC syndrome
29
Q

how would your rule in/our the diagnostic classification of shoulder pain and mobility deficits

A 
Rule in 
- age 40-65
- gradual one of progressive worsening of pain and ROM loss
- ROM loss following ER at side, abduction and IR at 90
- restricted joint motions
rule out
- PROM normal
- increase in rotation at 90 degree
-ULTT produces symptoms 
- postive tinels
30
Q

How would you rule in/out the shoulder stability and movement coordination treatment classification

A 
rule in 
- less than 40
- history of dislocation
- excessive GH accessory motion
- end range apprehension
rule out
- no dislocation history
- global GH motion loss
- no apprehension at end ragne
31
Q

how would you rule in/out muscle power deficit RTC syndrome

A 
Rule in
- symptoms increase with repetitive motion
- mid range catching
- pain production with MMT
- RTC weakness
rule out
- pain free resistance testing
- normal RTC strength
- significant PROM loss
32
Q

what recommendations are made regarding classification of tissue irritability

A 
High
- pain greater than 7
- consistent night or resting pain
- high self reported disability
- pain before end ranges of PROM or AROM
- AROM sign less than PROM
moderate
- 4-6 pain
- intermittent night or resting pain
- moderate self report disability 
- pain at end ranges of motion
- AROM similar to PROM
low
- pain less than 3
- no night or rest pain
- minimal self reported disability 
- pain with ROM over-pressure 
- AROM and PROM the same
33
Q

What type of imaging studies can help with differential diagnosis of Acap

A
  • Normal X-ray
  • arthrograph showing joint capsule capacity of less then 10-12mL
  • MRI- impairments of capsule and RTC interval as well as thickened coracohumeral ligaments and smaller axillary recess volume
  • US - fiborvasular inflammatory soft tissue changes of the RTC interval and increased thickness of the coracohumeral ligament (3mm to 1.3mm)
34
Q

what is the normal thickness of the coracohumeral ligament

A

1.33 mm

35
Q

what recommendations are made regarding classification of tissue irritability

A 
High
- pain greater than 7
- consistent night or resting pain
- high self reported disability
- pain before end ranges of PROM or AROM
- AROM sign less than PROM
moderate
- 4-6 pain
- intermittent night or resting pain
- moderate self report disability 
- pain at end ranges of motion
- AROM similar to PROM
low
- pain less than 3
- no night or rest pain
- minimal self reported disability 
- pain with ROM over-pressure 
- AROM and PROM the same
36
Q

What type of imaging studies can help with differential diagnosis of Acap

A
  • Normal X-ray
  • arthrograph showing joint capsule capacity of less then 10-12mL
  • MRI- impairments of capsule and RTC interval as well as thickened coracohumeral ligaments and smaller axillary recess volume
  • US - fiborvasular inflammatory soft tissue changes of the RTC interval and increased thickness of the coracohumeral ligament (3mm to 1.3mm)
37
Q

what is the normal thickness of the coracohumeral ligament

A

1.33 mm

clinical practice guidelines (10 decks)

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