Frozen Shoulder Flashcards

Question

Where is C spine-referred pain felt?

Answer 1

C spine-referred neck/back/m of arm pain depending on nerve affected

Answer 2

Movement performed by the patient. Tests “joint/capsule” and “muscles/tendons”

Answer 3

Movement performed by the examiner | - Tests “joint/capsule”

Answer 4

GH or capsule problem

Answer 5

“muscle/tendon” problem

Answer 6

Try to move against resistance, Tests tendons by isolating them: Abd 90 °, flex 30 ° int rot (thumb down) to align shoulder with scapula making sure its muscles your testing. Abd → Supraspinatus is the only abductor Internal rotation → subscapularus Ext. rot→ Infraspin. & Teres minor Abduction from neutral Shoulder flexion with elbow extended and Supination with elbow flexed tests the biceps.

Answer 7

``` Reproduce movements that cause greater tuberosity to ‘squash’ cuffagainst acromion, ACJ or coracoacromial ligament Rotator cuff (passive ) Stabilise scapula: Abduct 90, forward flex30 → int. rot. & elevate, Stabilise scapula, Full flexion=pain? ```

Answer 8

arthritis, capsulitis ‘frozen shoulder’

Answer 9

Rotator cuff tendinopathy, Bicipital tendinopathy, Calcific tendinopathy

Answer 10

Frozen Shoulder-“This is a condition of unknown aetiology in which there is a painful global restriction of GH movements in all planes, both active and passive, in the absence of joint degeneration (Xray/tests are normal) sufficient to explain this restriction" can be 1° or 2°

Answer 11

Prevalence: 2-3% in non-diabetics (10-20%in diabetics) Rare <40 Usually In 60's+ (diabetics may get it younger) Slight female preponderance 1.4:1, younger Contralateral 6-15% in 5yrs May be precipitated by trauma, M.I, C.V.A Associated with: thyroid disease, lung disease (TB, Ca.) cardiac disease/surgery

Answer 12

Painful (3-8/12): ache, night pain, spasm (initially not restricted so may be confused with RC problems) Adhesive (4-6/12): pain, stiffness, ↑ restriction Resolution (1-3yrs: less pain, gradual resolution (naturally occurs can't get to this stage quicker)

Answer 13

Early diff to d/w RCD, Tender trapezius, Global↓ROM (active & passive), Scapulohumeral rhythm, Disuse atrophy

Answer 14

Increased incidence in DM may implicate microvascular disease: abnormal collagen repair predisposition to infection Histology: ↑fibrous tissue, fibroblasts, type III collgen, vascularity, no↑in inflammatory, synovial cells No HCA or immunologic disturbance Genetic increase Trisomy 7 and 8 in fibroblasts of those with chronic disease Early phase more like neuropathic pain with allodynia Later phase similar to dupytrens in histology (but outcome different)

Answer 15

Evidence of sympathetic dysfunction (hyper reactivity) in the upper limbs of many with 'adhesive capsulitis'. (This can also potentially explain the increased association between hyperthyroidism and capsulitis.) Hypersensitivity of peripheral alpha adrenoreceptors and increased vasomotor tone (response to pain), may reduce blood supply to the capsule and lead to increased fibroblasts and collagen deposition and pain

Answer 16

Recovery: 1-2/3 have↓ROM, 10-15% have↓function No link b/t duration and outcome Corticosteroid reduce symptoms but not duration of disease,

Answer 17

Usually doesn’t require further investigation Radiography r/out: GH disease, calcific tendinopathy neoplasm Ultrasonograph: r/out RCD

Answer 18

Laser to treat frozen shoulder -release of thickened capsule

Answer 19

Early emphasis for pain reduction and to minimise restriction Physiotherapy: interferential, heat, acupuncture Corticosteroids: improve pain/ROM not duration Capsular distension: end of adhesive phase arthrography, US or blind Arthroscopic capsular release: arthroscopy with release of thickened capsule Manipulation under anaestheticrisk of rupture inf. capsule, SSC,elderly risk of fracture, RC rupture Immediate rehab NB++

Answer 20

Common cause of shoulder pain where degeneration of tendon leads to dysfunction and impingement

Answer 21

``` Painful arc (catching on lowering), deltoid, trauma Night-time pain, reduced function. Reduced active, better passive movements, pain on restricted Impingement test. If tender ++ consider calcific tendinopathy. If positive drop off or weakness ++ on external rotation consider complete rupture ```

Answer 22

Structural-Acromion, CA ligament, ACJ Functional- Fatigue, tendinopathy, instability Avascular zone

Answer 23

3 stages: 1) Oedema and hemorrhage, 2) Fibrosis and tendonitis, 3) Tendon degeneration, bony change, tendon rupture

Answer 24

Outcome is poor in elderly, cuff arthropathy Emphasis on cuff strengthening, reducing instability Corticosteroids reduce pain, & improve external rotation Surgical decompression depending on: Pain, Age, occupation, Structural abnormality

Answer 25

Nearly always with rotator cuff pathology Check Anterior stability, depress’s humeral head, Subluxation, Rupture biceps retraction

Answer 26

Trauma, OA, instability, Localised swelling/ pain, Tender | Use Provocation tests