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MSK Exam 3 > Frozen Shoulder Contracture Syndrome (FSCS) > Flashcards

Frozen Shoulder Contracture Syndrome (FSCS) Flashcards

1
Q

There are 3 functional questionnaires that are used for frozen shoulders, what are they and what do they stand for?

A
  • DASH: Disabilities of the Arm, Shoulder and Hand
  • ASES: American Shoulder and Elbow Surgeons shoulder scale
  • SPADI: Shoulder Pain and Disability Index
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2
Q

What is frozen shoulder also known as?

A

Adhesive Capsulitis

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3
Q

About what percentage of the population experiences a frozen shoulder?

A
  • 2 to 5.3%
  • Frequently misdiagnosed with any multi-directional limitation in ROM
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4
Q

What are the risk factors for frozen shoulder?

A
  • Associated with systemic low-grade inflammation (hyperthyroidism and diabetes)
  • 40-65 years of age
  • Biological female
  • Previous adhesive capsulitis
  • Family history
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5
Q

What is the primary cause of a frozen shoulder?

A

Due to pathology, particularly autoimmune conditions (I.e. diabetes, hyperthyroidism, etc.)

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6
Q

What is the secondary cause of a frozen shoulder?

A

Concomitant (happens at the same time as something else - or concurrent) injury and period of immobilization

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7
Q

Where is the inflammation typically located?

A

More often in the GH capsule and ligaments and it is persistent and can cause a fibrous contracture

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8
Q

T/F: Frozen shoulders can lead to reduced joint volume.

A

True

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9
Q

What type of impingement will most likely occur?

A

Hypomobile

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10
Q

What structures are involved in a frozen shoulder?

A
  • GH capsule and ligaments
  • Joint space
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11
Q

What kind of symptoms might you see?

A
  • Gradual and progressive pain and loss of motion
  • Functional limitations with reaching, sleeping, and other basic ADLs
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12
Q

When looking at ROM what motions will lose their range the most?

A
  • worst ER
  • then ABD
  • then FLEX
  • last IR
  • This is a capsular pattern of restriction
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13
Q

What kind of finding will you have with combined motions?

A

Consistent block

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14
Q

What will you find with resisted/ MMT?

A

Possibly weak and/or painful depending on the stage

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15
Q

Stress test will show what?

A

Distraction may be positive depending on the stage

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16
Q

Will accessory motion be hypomobile or hypermobile?

A

Hypomobile

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17
Q

Will you special tests be positive?

A

Yes, for impingement

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18
Q

How many stages of a frozen shoulder are there?

A

4

19
Q

What is stage 1?

A
  • 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
20
Q

What is stage 2?

A
  • Freezing
  • Constant pain, particularly at night
  • Highly irritable
  • Moderate to severe limitations in AROM compared to PROM
  • Empty and painful end feel
21
Q

What is stage 3?

A
  • 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
22
Q

What is stage 4?

A
  • Thawing
  • Minimal to no pain
  • Low irritability
  • ROM gradually improves
  • Firm end feel
23
Q

Is there a gold standard test and measure for frozen shoulder?

A

No

24
Q

What will images look like for frozen shoulders?

A

Normal radiographs

25
Q

Are you able to diagnose frozen shoulders early?

A

Early diagnosis is very difficult due to irritability

26
Q

What is the most common “test and measure” for a frozen shoulder

A

The clinical presentation of the patient

27
Q

What kind of patient education should you do for a frozen shoulder?

A
  • 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
28
Q

What kind of benefit does cryotherapy have for frozen shoulder?

A

Additional benefit to joint mobilization and modalities for pain, ROM, and function

29
Q

What kind of benefit does laser have for frozen shoulder?

A

Evidence for short term and long term functional changes

30
Q

What kind of benefit does diatherapy, US, and e-stem have for frozen shoulder?

A

Weak, if any evidence

31
Q

What kind of benefits do joint mobilizations have for frozen shoulder?

A
  • 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
32
Q

What kind of benefits does STM for ROM and flexibility have for frozen shoulder?

A

Moderate evidence

33
Q

What is the goal for METs?

A

Focus primarily for elasticity and mobility increases but to also offset disuse, particularly with inhibited muscles as you need to control improving mobility

34
Q

T/F: Multimodal approach is effective for most patients with frozen shoulders.

A

True

35
Q

What kind of evidence do oral steroids have for frozen shoulders?

A

Moderate evidence for short term benefit

36
Q

What kind of evidence do cortisone injections have for frozen shoulders?

A
  • Short and mid-term benefit
  • Short term benefit when added to therapeutic exercise and joint mobilizations
37
Q

How effective are manipulations under anesthesia?

A
  • They have questionable effectiveness
  • No difference to exercise alone
  • Recalcitrant (stubborn) conditions respond well
38
Q

T/F: Capsular release is supported for frozen shoulders.

A

False

39
Q

How long does stage 1 last?

A

About 1 to 2 months

40
Q

How long does the pain and mobility deficits last?

A

May last 12 to 18 months

41
Q

T/F: Most achieve minimal symptoms and deficits in recovery.

A

True

42
Q

If a frozen shoulder is untreated how long may it take to resolve?

A

12 to 42 months

43
Q

About 50% of people who go untreated will have pain for how many years?

A

4.5 to 7 years

MSK Exam 3 (9 decks)

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