Adhesive Capsulitis

Question 1

What is adhesive capsulitis?

Answer 1

“frozen shoulder”

-inflammation of joint capsule can causing tightness

Question 2

Factors associated with adhesive capsulitis:

Answer 2

• Women> men
• > 40 y/o
• DM (5-6x more likely)
• Prior hx in either shoulder
• Thyroid disease
• Prolonged immobilization

Question 3

Adhesive capsulitis is most commonly ________, but can be secondary to ______

Answer 3

idiopathic

trauma

Question 4

Are there special tests for adhesive capsulitis?

Answer 4

No

Question 5

What is the capsular pattern?

Answer 5

Most significant loss of ROM observed with ER with arm by side
-ROM is limited passive and actively

Question 6

Clinical Progression

Answer 6

Four stages of pathology

Question 7

Natural Progression

Answer 7

Normal function about 2 years following onset

Question 8

Stage 1: “Pre-adhesive” (0-3 months)

Answer 8

• mild sx: achy at rest, sharp at end range
• often mistaken for shoulder impingement
• progressive loss of ROM in capsular pattern, especially early loss of ER
• Strength intact, but may hurt

Question 9

Why could strength be intact, but pt could still have pain?

Answer 9

Guarding causes tender muscles

Question 10

Stage II: “Freezing stage” (3-9 months)

Answer 10

• persistent more intense pain, even at rest
• multidirectional motion loss, pain especially at end ranges
• pain often referred to lateral upper arm
• night pain common

Question 11

In what stage would an intraarticular steroid injection be beneficial for reducing pain, inflammation, and improving ROM?

Answer 11

Stage 1 or 2

Question 12

Stage III: “Frozen” (9-14 months)

Answer 12

• Hx of painful stiffening shoulder and significant ROM loss in capsular pattern
• Pain may be lessening overall compared to stage II, but still significant ROM loss
• Poor scapulohumeral rhythm often observed

Question 13

Why could a patient with frozen shoulder have poor scapulohumeral rhythm?

Answer 13

Because they have not used those muscles in a while

-“Use it or lose it”

Question 14

Stage IV: “Thawing” (15-24 months)

Answer 14

• minimal pain
• gradual return in ROM
• stiffness may remain
• tissue: fibrosis remain, receding synovial involvement

Question 15

Medical interventions:

Answer 15

• Pharmacologic: NSAIDs, oral steroids
• Intra-articular steroid injections
• Manipulation under anesthesia (MUA)
• Hydrodilation (Brisement)
• Arthroscopy
• Open release