CPG Adhesive cap Flashcards
What is the hallmark clinical finding of adhesive capsulitis
lass of passive ROM, particularly ER with arm at the side and varying degrees of shoulder abduction
- theoretical evidence
what are the risk factors associated with Acap
DM (men and women) and hypoThyroid disease (women), h/o duputren’s disease
- moderate evidence
Acap is most prevalent in what populations
females general population, DM male (33%, females 26%), age 45-65 (peak 51-55), with history of contralateral Acap
- Moderate evidence
How long does Acap typical take to resoluve
12-18 months
what disability indexes have been validated for Acap
- DASH
- Shoulder and elbow surgeons shoulder sale (ASES)
- Shoulder pain and disability index (SPADI)
- Strong evidence
Describe the role of corticosteroid injections in Acap
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
What are the educational recommendations for Acap
- understand the natural course of the disease
- promote activity modification to encourage functional pain free motion
- match intensity of stretching to patient current level of irritability
- moderate evidence
what modalities are recommend for Acap
Week evidence suggests short wave diathermy, US and estim when combined with stretching and joint mobs can help control symptoms
What forms of treatment are recommend for Acap
- joint mobs weak evidence
- manipulation under anesthesia weak evidence
- stretching matched to stage of irritability moderate evidence
how does the prevalence of shoulder pain compare to the prevalence of Acap in the general population
shoulder pain 2.4-26%
ACap 2-5.3%
Subscapularis will restrict what motins
ER at 0
Cadaver sides of Acap demonstrates what pathoanatomic features
Limitations of the proximal portions of the capsuloligamentous complex and subscap tendon
what is rotator cuff interval
- 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
what is the pathoanatomic origin of Acap
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
What causes Acap
unkown
Level IV evidence also suggest what risk factors
- prolonged immobilization
- MI
- trauma
- autoimmune disease
describe the clinical course of Acap
4 stages
- up to 3 months - sharp end range pain, ache at rest and difficulty sleeping. marked synovial irritation without contracture
- 3-9 months - gradual loss of motion - aggressive synovitis with some ROM loss under anesthesia
- 9-15 months - reduction of synovitis and resultant fibrosis
- 15-24 months - pain reaction with gradual return of ROM
What are the MSK clinical signs typically used to identify Acap
- 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
what factors are predictive of Manipulation for Acap
- prior rehab
- work comp claim
- pending litigation
How does the course of recovery differ for function and pain with Acap
- 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
what is the difference between primary and secondary Acap
- primary has no associated health conditions
2. secondary is linked to a disease or pathology
what are the subcategories of secondary Acap
- systemic
- extrinsic
- intrinsic
what are the conditions associated with systemic secondary Acap
- DM
2. thyroid disease
what are the conditions associated with extrinsic secondary Acap
- CVA
- intrathoracic conditions such as MI or COPD
- intra-abdominal conditions
- cerivcal disc disease
- distal extremity fractures
- self imposed immobilization
what conditions are associated with intrinsic secondary Acap
things within the GH
- RTC and bicep tendonopathies
- AC and GH arthropathies
- proximal humeral or scapular fractures
describe the data surround cyriax capsular pattern
- 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
what the the Acap clinical practice guidelines
- component 1 - Medical screening to determine if the person is appropriate for physical therapy
- component 2 - differential evaluation for MSK impairment of body function (ICF) and associated tissue pathology (ICD)
- component 3: diagnosis of tissue irritability level
- component 4: interventional strategies
What diagnostic classifications are suggested for the shoulder
- shoulder pain and mobility deficits/Acap
- shoulder stability and movement coordination impairments (dislocation, sprain strain)
- shoulder pain and muscle power deficits and RTC syndrome
how would your rule in/our the diagnostic classification of shoulder pain and mobility deficits
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
How would you rule in/out the shoulder stability and movement coordination treatment classification
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
how would you rule in/out muscle power deficit RTC syndrome
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
what recommendations are made regarding classification of tissue irritability
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
What type of imaging studies can help with differential diagnosis of Acap
- 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)
what is the normal thickness of the coracohumeral ligament
1.33 mm
what recommendations are made regarding classification of tissue irritability
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
What type of imaging studies can help with differential diagnosis of Acap
- 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)
what is the normal thickness of the coracohumeral ligament
1.33 mm
