Frozen shoulder Flashcards
Prevalence
20-30% elderly, >70% rotator cuff disease
4 joints in skeleton
- Glenohumeral
- Acromioclavicular
- Sternoclavicular
- Scapulothoracic
Glenohumeral joint
Superior, middle, inferior ligaments
Acromioclavicular
Fibrous, little movement, full abduction, adduction and flex, interacts with subacromial space (acromioclavicular and coracoclavicular joints)
Sternoclavicular
Rotates with elevation 30-40
Scapulothoracic
Lies against posterior lateral thoracic wall, origin for rotator cuff muscles, deltoid and trapezius
What affects stability?
Capsule, labrum, ligaments, rotator cuff muscles, long head biceps
Imbalance of muscle strength/hypermobility >
Higher risk of impingement/tendonopathy
Adduction
Pec major and lat dorsi
Flexion
Pec major and deltoid
Extension
Lat dorsi, teres major and deltoid
Lateral rotation
Infraspinatus, teres minor
Medial rotation
Pec major, lat dorsi, deltoid , subscapularus
Subacromial bursa
Between supraspinatus tendon and acromion
Injury shoulder >
Rotator cuff injury, stress capsule, bicipital tendinitis, instability, tear
Adhesive capsulitis
Deep aching
Inspection
- Swelling/deformity
- Neck position
- Muscle wasting
- Asymmetry of scapulohumeral rhythm
- Scapula winging
- Tendon rupture - biceps
Tests
- Stability - draw test, sulcus sign
- Apprehension
Problems at joint/capsule
Arthritis, capsulitis (frozen shoulder)
Problems at tendons
Rotator cuff tendinopathy, bicipital tendinitis, calcific tendinitis
Adhesive capsulitis/Frozen shoulder
Painful global restriction of GH movements in all planes (active and passive), absence of joint degeneration
Frozen shoulder prevalence
2-3%, rare M
Frozen shoulder precipitated by
Trauma, MI, CVA
Frozen shoulder associations
- Diabetes (10-20%, risk increases with duration)
- Thyroid disease
- Lung disease (TB, Ca)
- Cardiac disease/surgery
Frozen shoulder painful
Ache, night pain, spasm
Frozen shoulder adhesive
Pain, stiffness, restriction
Frozen shoulder resolution
Less pain, gradual resolution
Pathophysiology
Increased incidence in DM - microvascular disease, abnormal collagen repair, predisposition to infection
Histology
Increased fibrous tissue, fibroblasts, type 3 collagen, vascularity increase in inflammation, synovial cells
Genetic
Increase in trisomy 7 and 8 in fibroblasts
Pathophysiology
Early - neuropathic pain with allodynia
Late - dupytrens in histology
Treatment
Corticosteroids - reduce symptoms, capsular distension (enlarge), manipulation under anaesthetic
Investigations
- Usually clinical diagnosis
- Radiography - GH disease/calcific tendinitis, neoplasm
- Arthrography
- Ultrasonography
Rotator cuff tendonitis
Common cause of shoulder pain, degeneration > dysfunction and impingement
History for Rotator cuff tendonitis
Painful arc, deltoid, trauma, night-time pain, reduced function, occupation
Rotator cuff tendonitis examination
Painful arc, reduced active, better passive movements, impingement
Rotator cuff tendonitis pathophysiology (Neer)
- Oedema and haemorrhage
- Fibrosis and tendonitis
- Tendon degeneration, bony change, tendon rupture
Imagining
- Plain radiography
- Ultrasonography
- MRI
- Arthrography
- Arthroscopy
