Frozen shoulder

Question 1

Also known as?

Answer 1

Adhesive capsulitis

Question 2

What is a key risk factor

Answer 2

Diabetes

Question 3

What are the two main categories of frozen shoulder

Answer 3

Primary - spontaneous without any trigger
Secondary - in response to trauma, surgery, immobilisation

Question 4

Explain the pathophysiology

Answer 4

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.

Question 5

What are the 3 phases of presentation ?

Answer 5

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

Question 6

How long does it last before resolving?

Answer 6

1-3 years
Up to 50% have persistent symptoms

Question 7

What are the differentials

Answer 7

Supraspinatus tendinopathy
Acromioclavicular joint arthritis
Glenohumeral joint arthritis
Septic arthritis
Inflammatory arthritis
Malignancy

Question 8

What is supraspinatus tendinopathy?What causes it?

Answer 8

Inflammation of the supraspinatus tendon
Usually due to impingement at the point where it passes between the humeral head and the acromion

Question 9

What test can be used to assess for supraspinatus tendinopathy?

Answer 9

Empty can test (Jobe test)
Abduct shoulder to 90 degrees
Fully internally rotate arm as though emptying can of water
Examiner pushes down on the arm whilst pt resists
Positive if pain or arm gives way

Question 10

How can acromioclavicular joint arthritis be demonstrated on examination?

Answer 10

Tender to palpate AC joint
Positive scarf test, pain worse by wrapping arm across the chest and opposite shoulder

Question 11

How is adhesive capsulitis diagnosed

Answer 11

Clinically

Question 12

What is non-surgical management

Answer 12

Analgesia
Physio
Intra-articular steroid injections
Hydrodilation - injecting fluid into the joint to stretch the capsule

Question 13

What are surgical options for treatment of adhesive capsulitis?

Answer 13

Manipulation under anaesthesia - forcefully stretching the capsule to improve ROM
Arthroscopy - keyhole surgery to cut adhesions and release the shoulder