Week 1: Shoulder Adhesive Capsulitis: AKA the Frozen Shoulder Syndrome Flashcards
What is adhesive capsulitis?
Condition w/ pain and stiffness or motion loss in the shoulder
Symptoms associated w/ adhesive capsulitis
- Sleep deprivation
- Anxiety
- Disability
Average duration of adhesive apsulitis
30.1 months
How common is adhesive capsulitis
- 5.3% of population
- 10-38% of pop w/ diabetes or thyroid disease
- Females > males
Pathogenesis of adhesive capsulitis
Cause unknown, results in:
- Hardening of redundant axillary folds
- Synovial capsule thickening
- Contracture of GH joint
- Dense adhesions on the synovial capsule
- Significant loss of AROM/PROM
Classifications for adhesive capsulitis
- Primary (idiopathic)
- Secondary
Primary (idiopathic) adhesive capsulitis
- Histological
- Neuronal
- Vascular
Histological changes in adhesive capsulitis
- Inflammatory cytokines
- Fibroblasts - myofibroblasts
- Lymphocytes
Neuronal and vascular abnormalities
Increased vascularity in the anterosuperior joint capsule but not in the inferior or posterior capsule
Secondary adhesive capsulitis
- Systemic
- Extrinsic (outside the joint)
- Intrinsic (inside the joint)
Systemic Secondary adhesive capsulitis
- Diabetes mellitus
- Hypothyroidism
- Hyperthyroidism
- Hypoadrenalism
Extrinsic Secondary adhesive capsulitis
- Cardiopulmonary disease
- Cervical disc
- CVA
- Humerus fractures
- Parkinson’s
Intrinsic Secondary adhesive capsulitis
- Rotator cuff tendinitis
- Rotator cuff tears
- Biceps tendinitis
- Calcific tendinitis
- AC arthritis
Stages of adhesive capsulitis
Stages 1-4
Adhesive capsulitis stage 1
- 0-3 months
- Non-capsular limitations
- Pain w/ AROM/PROM
Adhesive capsulitis stage 2
- “Freezing”
- 3-9 months
- Capsular pattern limitation
Adhesive capsulitis stage 3
- “Frozen”
- 9-15 months
- High irritability
- Rigid end feel
Adhesive capsulitis stage 4
- “Thawing”
- 15-24 months
- Low irritability
- Gradual return ROM
Patient presentation for adhesive capsulitis
- Gradual and progressive onset of pain
- Rain at end ranges of movement
- Painful and restricted AROM/PROM in elevation and rotation for 1+ month
Capsular pattern in adhesive capsulitis
ER –> ABD –> IR
Differential diagnosis for adhesive capsulitis
Diagnostic imaging usually needed
Treatment options for adhesive capsulitis
- Wait and see
- PT
- Oral steroid
- Corticosteroid injections
- Manipulation under anesthesia
- Arthroscopy
Level A evidence for adhesive capsulitis
Steroid injections + PT
Level B evidence for adhesive capsulitis
- Pt education
- Stretching
Level C evidence for adhesive capsulitis
- Modalities
- Mob/manip
