frozen shoulder

Question 1

what is a key risk factor for adhesive capsulitis?

Answer 1

Diabetes

Question 2

what is the pathophysiology of adhesive capsulitis?

Answer 2

The glenohumeral joint is the ball and socket joint in the shoulder. The glenohumeral joint is surrounded by connective tissue that forms the joint capsule.

In adhesive capsulitis, inflammation and fibrosis in the joint capsule lead to adhesions (scar tissue). The adhesions bind the capsule and cause it to tighten around the joint, restrict movement in the joint.

Adhesive capsulitis can be:

• Primary – occurring spontaneously without any trigger
• Secondary – occurring in response to trauma, surgery or immobilisation

Question 3

what are the phases of the condition and how long do they last?

Answer 3

Painful phase – shoulder pain is often the first symptom and may be worse at night

Stiff phase – shoulder stiffness develops and affects both active and passive movement (external rotation is the most affected) – the pain settles during this phase

Thawing phase – there is a gradual improvement in stiffness and a return to normal

The entire illness lasts 1 – 3 years before resolving (e.g., 6 months in each phase). However, a large number of patients (up to 50%) have persistent symptoms.

Question 4

what are the main differentials to consider for a patient with shoulder pain not preceded by trauma?

Answer 4

Supraspinatus tendinopathy

Acromioclavicular joint arthritis

Glenohumeral joint arthritis

Question 5

what are rare but important differentials to keep in mind?

Answer 5

Septic arthritis- fever
Inflammatory arthritis
Malignancy (e.g., osteosarcoma or bony metastasis) - b signs

Question 6

what are differentials to consider if shoulder pain occurs after trauma?

Answer 6

Shoulder dislocation
Fractures (e.g., proximal humerus, clavicle or rarely the scapula)
Rotator cuff tear

Question 7

how can you demonstrate acromioclavicular joint arthritis on examination?

Answer 7

Tenderness to palpation of the AC joint

Pain is worse at the extremes of the shoulder abduction, from around 170 degrees onwards when the arm is overhead

Positive scarf test – pain caused by wrapping the arm across the chest and opposite shoulder

Question 8

what will imaging show for adhesive capsulitis?

Answer 8

• diagnosis is clinical
• xray will be normal
• USS CT and MRI may show thickened joint capsule

Question 9

what is the cause of supraspinatous tendonopathy?

Answer 9

involves inflammation and irritation of the supraspinatus tendon, due to impingement at the point where it passes between the humeral head and the acromion.

common in athletes participating in overhead sports-> basketball, tennis, volleyball

Question 10

which test would you preform to assess for supraspinatous tendinopathy?

Answer 10

jobes test

• abduct and internally rotate arm and then examiner will push down

Question 11

what is the medical management for an adhesive capsulitis?

Answer 11

• continue sing arm, but don’t exacerbate pain
• analgesia- NSAIDS
• physiotherapy
• intra-articular joint steroid injections
• hydrodilation

Question 12

what is the surgical management of adhesive capsulitis?

Answer 12

Manipulation under anaesthesia – forcefully stretching the capsule to improve the range of motion

Arthroscopy – keyhole surgery on the shoulder to cut the adhesions and release the shoulder