Frozen Shoulder Flashcards
What is frozen shoulder also called?
Adhesive capsulitis
Who is most commonly affected by frozen shoulder?
Middle-aged
Diabetics
What is primary and secondary frozen shoulder?
Primary- occurs spontaneously without any trigger
Secondary- occurs in response to trauma, surgery or immobilisation
What is the pathophysiology of frozen shoulder?
Inflammation and fibrosis in the joint capsule cause adhesions
Adhesions bind the capsule causing it to tighten, restricting movement
What are the three phases of presentation of frozen shoulder?
Painful phase
Shoulder pain, worse at night
Stiff phase
Shoulder stiffness, affects both active and passive movements
External rotation is most affected
Pain settles in this phase
Thawing phase
Gradual improvement in stiffness and return to normal
How long does frozen shoulder typically last?
1-3 years, each phase typically 6 months
Do symptoms persist after recovery?
50% of the time symptoms will persist after recovery
What differentials should be considered if a patient with shoulder pain presents without any trauma or acute injury?
Supraspinatus tendinopathy
Acromioclavicular joint arthritis
Glenohumeral joint arthritis
What rare differentials should be considered for patients without any acute trauma or injury with shoulder pain?
Septic arthritis
Inflammatory arthritis
Malignancy (e.g. osteosarcoma or bony metastasis)
If shoulder pain is preceded by trauma what differentials should be considered?
Shoulder dislocation
Fractures
Rotator cuff tear
What causes supraspinatus tendinopathy?
Mainly due to impingement where the supraspinatus tendon passes between the humeral head and acromion
What can be used to assess supraspinatus tendinopathy?
Empty can test
How can acromioclavicular joint arthritis be demonstrate on examination?
Tenderness to palpation
Pain worse at extremes of shoulder abduction, 170 degrees onwards (when arm is overhead)
Positive scarf test
How is frozen shoulder diagnosed?
Clinical diagnosis based on history and examination
Exclusion other causes
What imaging is used for diagnosis of frozen shoulder?
X-rays
Usually normal, excludes osteoarthritis
Ultrasound, CT, MRI
Shows thickened joint capsule
