Frozen Shoulder Contracture Syndrome (FSCS) Flashcards
There are 3 functional questionnaires that are used for frozen shoulders, what are they and what do they stand for?
- DASH: Disabilities of the Arm, Shoulder and Hand
- ASES: American Shoulder and Elbow Surgeons shoulder scale
- SPADI: Shoulder Pain and Disability Index
What is frozen shoulder also known as?
Adhesive Capsulitis
About what percentage of the population experiences a frozen shoulder?
- 2 to 5.3%
- Frequently misdiagnosed with any multi-directional limitation in ROM
What are the risk factors for frozen shoulder?
- Associated with systemic low-grade inflammation (hyperthyroidism and diabetes)
- 40-65 years of age
- Biological female
- Previous adhesive capsulitis
- Family history
What is the primary cause of a frozen shoulder?
Due to pathology, particularly autoimmune conditions (I.e. diabetes, hyperthyroidism, etc.)
What is the secondary cause of a frozen shoulder?
Concomitant (happens at the same time as something else - or concurrent) injury and period of immobilization
Where is the inflammation typically located?
More often in the GH capsule and ligaments and it is persistent and can cause a fibrous contracture
T/F: Frozen shoulders can lead to reduced joint volume.
True
What type of impingement will most likely occur?
Hypomobile
What structures are involved in a frozen shoulder?
- GH capsule and ligaments
- Joint space
What kind of symptoms might you see?
- Gradual and progressive pain and loss of motion
- Functional limitations with reaching, sleeping, and other basic ADLs
When looking at ROM what motions will lose their range the most?
- worst ER
- then ABD
- then FLEX
- last IR
- This is a capsular pattern of restriction
What kind of finding will you have with combined motions?
Consistent block
What will you find with resisted/ MMT?
Possibly weak and/or painful depending on the stage
Stress test will show what?
Distraction may be positive depending on the stage
Will accessory motion be hypomobile or hypermobile?
Hypomobile
Will you special tests be positive?
Yes, for impingement
How many stages of a frozen shoulder are there?
4
What is stage 1?
- Initial
- Gradual onset
- Achy at rest
- Sharp with use
- Night pain is common
- Unable to lie on the involved side
- Highly irritable
- AROM is significantly less than PROM
- Empty and painful end feel
What is stage 2?
- Freezing
- Constant pain, particularly at night
- Highly irritable
- Moderate to severe limitations in AROM compared to PROM
- Empty and painful end feel
What is stage 3?
- Frozen
- Stiffness is greater than the pain
- Intermittent pain
- Moderate irritability
- Moderate to severe limitations with pain at end range
- AROM is equal to PROM
- Firm end feel
What is stage 4?
- Thawing
- Minimal to no pain
- Low irritability
- ROM gradually improves
- Firm end feel
Is there a gold standard test and measure for frozen shoulder?
No
What will images look like for frozen shoulders?
Normal radiographs
Are you able to diagnose frozen shoulders early?
Early diagnosis is very difficult due to irritability
What is the most common “test and measure” for a frozen shoulder
The clinical presentation of the patient
What kind of patient education should you do for a frozen shoulder?
- POLICED
- Describe natural course of the 4 stages
- Promote pain free functional activity
- Match intensity of stretching and joint mobilizations with signs and symptoms always
What kind of benefit does cryotherapy have for frozen shoulder?
Additional benefit to joint mobilization and modalities for pain, ROM, and function
What kind of benefit does laser have for frozen shoulder?
Evidence for short term and long term functional changes
What kind of benefit does diatherapy, US, and e-stem have for frozen shoulder?
Weak, if any evidence
What kind of benefits do joint mobilizations have for frozen shoulder?
- Mixed benefits for pain and ROM
- Grade 3-4 have moderate evidence for short and long term benefits
- Inconsistent benefit for ROM added to exercise in shoulders with gradual onset
- Weak evidence
What kind of benefits does STM for ROM and flexibility have for frozen shoulder?
Moderate evidence
What is the goal for METs?
Focus primarily for elasticity and mobility increases but to also offset disuse, particularly with inhibited muscles as you need to control improving mobility
T/F: Multimodal approach is effective for most patients with frozen shoulders.
True
What kind of evidence do oral steroids have for frozen shoulders?
Moderate evidence for short term benefit
What kind of evidence do cortisone injections have for frozen shoulders?
- Short and mid-term benefit
- Short term benefit when added to therapeutic exercise and joint mobilizations
How effective are manipulations under anesthesia?
- They have questionable effectiveness
- No difference to exercise alone
- Recalcitrant (stubborn) conditions respond well
T/F: Capsular release is supported for frozen shoulders.
False
How long does stage 1 last?
About 1 to 2 months
How long does the pain and mobility deficits last?
May last 12 to 18 months
T/F: Most achieve minimal symptoms and deficits in recovery.
True
If a frozen shoulder is untreated how long may it take to resolve?
12 to 42 months
About 50% of people who go untreated will have pain for how many years?
4.5 to 7 years
