Adhesive Capsulitis Flashcards

1
Q

Red flags for shoulder pain in primary care

A
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2
Q

Proceeding events/problems that can result in frozen shoulder

A
  • Rotator cuff disease - tendinopathy/impingement
  • Trauma/previous surgery
  • Prolonged immbolisation
  • Known joint arthropathy
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3
Q

Co-morbidities associated with adhesive capsulitis

A
  • AI disease
  • Diabetes
  • Thyroid dysfunction
  • Hyperlipidaemia
  • Decreased mobility - Parkinsons, cardiac problems
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4
Q

What happens in adhesive capsulitis?

A
  • Glenohumeral joint capsule becomes contracted and adherent to humeral head
  • = shoulder pain and reduced ROM
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5
Q

Pathophys of adhesive capsulitis

A
  • Primary - idiopathic
  • Secondary - causes mentioned in previous card
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6
Q

Presentation of adhesive capsulitis

A
  • Deep and constant pain
  • Disturbs sleep
  • May radiate to bicep
  • Loss of arm swing
  • Atrophy of deltoid muscle
  • Generalised tenderness
  • Limited ROM - primarily affects external rotation and flexion
  • Active and passive movements affected
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7
Q

Differentials for shoulder pain

A
  • Frozen shoulder
  • Acromioclavicular pathology - joint injury, arthiritis
  • Subacromial impingement syndrome - painful arc, preserved passive movements, history of overuse
  • Muscular tear - weakness perists when shoulder pain relieved
  • AI disease eg polymyalgia rheumatica - polyarthropathy and systemic symptoms
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8
Q

Investigations for frozen shoulder

A
  • Plain x-rays - rule out acromioclavicular pathology or atypical #
  • MRI - thickening of glenohumeral joint capsule, also rules out subacromial impingement syndrome
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9
Q

Bloods for AC

A
  • HbA1C - associated with diabetes
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10
Q

Management AC

A
  • Recovery takes months to years
  • Some patients never recover full ROM
  • Physiotherapy
  • Manage pain - WHO
  • Glenohumeral joint corticosteroid injections
  • Surgery if none of this works
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11
Q

Surgery options AC

A
  • Joint manipulation with GA to remove capsular adhesions
  • Arthrographic distension - fluid into joint space, break up adhesions
  • Surgical release of glenohumeral joint capsule
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12
Q

Complications of AC

A
  • Never regain full ROM
  • Recurrence in contralateral shoulder
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13
Q

3 phases of AC

A
  • Freezing - 6-9 weeks - slow pain and stiffness
  • Frozen - 4-6months - reducing pain, stiffness remains
  • Thawing - 6months - 2yrs - regain ROM slowly
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14
Q

Management options list for AC

A
  • Physio
  • NSAIDs
  • Oral corticosteroids
  • Intra-articular steroids
  • Surgery
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15
Q

Complications of intra-articular steroid injections

A
  • Septic arthiritis
  • Skin atrophy and hypopigmentation
  • Post-injection flare - pain increases
  • Infection
  • Tendon/ligament rupture
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16
Q
A