Upper limb frozen shoulder and rot Flashcards
What is another name for frozen shoulder?
Adhesive capsulitis
Frozen shoulder is commonly referred to as adhesive capsulitis.
What are the main characteristics of frozen shoulder?
- Progressive pain
- Stiffness
- Resolves spontaneously after about 18 months
Frozen shoulder has a natural tendency to resolve on its own over time.
What histological features are similar in frozen shoulder and which disease?
Dupuytren’s disease
Both conditions exhibit active fibroblastic proliferation.
What are some associated conditions/risk factors for frozen shoulder?
- Age 40 – 60 years
- Diabetes
- Dupuytren’s disease
- Hyperlipidaemia
- Cardiac disease
- Hemiplegia
These risk factors can increase the likelihood of developing frozen shoulder.
What is the typical progression of symptoms in frozen shoulder?
- Pain gradually increases (months)
- Stiffness increases as pain subsides (6-12 months)
- Gradual movement is regained
Some patients may not return to normal and may experience persistent pain.
What are the two characteristic features for diagnosing frozen shoulder?
- Painful restriction of movement
- Normal x-rays
Diagnosis is clinical and does not rely on imaging alone.
What are the three phases of frozen shoulder?
- Painful stage
- Frozen/adhesive stage
- Thawing stage
Each phase represents a different stage in the progression of the condition.
What is a differential diagnosis for frozen shoulder?
- Infection
- Post traumatic stiffness
- Diffuse stiffness
- Reflex sympathetic dystrophy
These conditions may present with similar symptoms and should be considered.
What is the aim of conservative treatment for frozen shoulder?
Relieve pain and prevent stiffness
Conservative management is typically the first line of treatment.
What medications are used in the conservative treatment of frozen shoulder?
- Analgesics
- NSAIDs
These medications help manage pain associated with the condition.
What is the main indication for surgical treatment of frozen shoulder?
Prolonged and disabling restriction in movement after failed conservative treatment
Surgical options are considered when conservative measures do not yield results.
What is rotator cuff impingement also known as?
Subacromial impingement
This condition is a common cause of shoulder pain.
What are the stages of rotator cuff disease leading from impingement?
- Impingement and bursitis
- Partial to full thickness tear
- Massive rotator cuff tears
- Rotator cuff tear arthropathy
Rotator cuff impingement is considered the first stage in this continuum.
What are the two main components of the pathophysiology of rotator cuff impingement?
- Extrinsic compression
- Intrinsic degeneration of supraspinatus
These factors contribute to the development of impingement syndrome.
What are some associated conditions with rotator cuff impingement?
- Hook shaped acromion
- Os acromiale
- Posterior capsular contracture
- Scapular dyskinesia
- Tuberosity fracture malunion
- Instability
These conditions can exacerbate or contribute to impingement.
What are common symptoms of rotator cuff impingement?
- Pain
- Insidious onset
- Exacerbated by overhead activities
- Night pain
Symptoms may vary in intensity and duration.
What special tests are used to diagnose rotator cuff impingement?
- Painful arc test
- Neer impingement sign
- Neer impingement test
- Hawkins test
- Jobe test
- Yocum test
These tests help assess shoulder function and pain.
What does the Painful Arc Test indicate?
Pain when the arm is abducted in the scapular plane from 60° – 120°
This test is used to assess for impingement.
What is the Neer impingement sign?
Hand pronated & put into flexion > 90°
This maneuver assesses for shoulder impingement.
What does the Neer impingement test involve?
Injecting local anaesthetic into subacromial space relieves pain
This test helps confirm the diagnosis of impingement.
What is the Hawkins test?
Arm forward flexion to 90° followed by forcible internal rotation
This test is designed to elicit pain indicative of impingement.
What does the Jobe test (empty can test) assess?
Patient attempts to elevate the arms against resistance with elbows extended and arms abducted
This test evaluates the strength and integrity of the rotator cuff.
What is the Yocum test?
Patient puts hand on the opposite shoulder and elevates the elbow
This test also evaluates for impingement.
What imaging studies are used in the investigation of rotator cuff impingement?
- X-rays
- Ultrasound
- MRI
- CT arthrography
These imaging modalities help assess the condition of the shoulder.
What is the non-operative management for rotator cuff impingement?
- Oral NSAIDs
- Physical therapy
- Subacromial injections
These conservative measures aim to alleviate symptoms.
What is the operative management for rotator cuff impingement?
Subacromial decompression/acromioplasty
Surgical intervention is considered if conservative treatment fails.
