Adhesive Capsulitis and Acute Calcific Tendonitis

Question 1

What characterises adhesive capsulitis?

Answer 1

Progressive pain and stiffness of the shoulder

Question 2

Who does adhesive capsulitis tend to affect?

Answer 2

Aged 40-50 (but up to 60)

Question 3

How long does it take for adhesive capsulitis to resolve?

Answer 3

18-24 months

Question 4

Patients with adhesive capsulitis will initially complain of what? When will this resolve?

Answer 4

Pain- resolves after 2-9 months

Question 5

When will there be pain in adhesive capsulitis?

Answer 5

All the time, including at rest and at night

Question 6

What occurs after the pain has died down in adhesive capsulitis? How long does this last?

Answer 6

Stiffness for 4-12 months

Question 7

What happens after the stiffness in adhesive capsulitis?

Answer 7

The stiffness ‘thaws out’ over time, with fairly good recovery of shoulder motion

Question 8

What is the principle clinical sign for adhesive capsulitis?

Answer 8

Loss of external rotation

Question 9

Restriction of which movements will occur in adhesive capsulitis?

Answer 9

All movements

Question 10

Adhesive capsulitis often presents similar to what condition? Without any tests, what can often tell them apart?

Answer 10

OA- usually adhesive capsulitis will affect younger patients

Question 11

Is there a history of a triggering event in adhesive capsulitis?

Answer 11

Sometimes, but more often not. It can be an inflammatory response to impingement.

Question 12

Give 3 factors which increase likelihood of adhesive capsulitis?

Answer 12

Diabetic, hypercholesterolaemia, Dupuytren’s disease

Question 13

What is the similarity between Dupuytren’s and adhesive capsulitis?

Answer 13

Thickening of fascia histologically

Question 14

What happens to the joint capsule and glenohumeral ligaments in adhesive capsulitis?

Answer 14

Inflammation, and then thicken and contract

Question 15

What is the aim of treatment for adhesive capsulitis?

Answer 15

Relieve pain and prevent further stiffening while the condition resolves naturally

Question 16

What treatments can be useful in adhesive capsulitis?

Answer 16

Physiotherapy. Analgesics and joint injections (in the painful phase)

Question 17

Where are the joint injections used in adhesive capsulitis?

Answer 17

Glenohumeral

Question 18

If the patient with adhesive capsulitis cannot tolerate the loss of function due to stiffness, what can be done to speed up recovery?

Answer 18

Manipulation under anaesthetic to tear the capsule or surgical capsular release which divides the capsule

Question 19

What is the rehabilitation for the surgical options used for adhesive capsulitis?

Answer 19

Arm will be moving in a few weeks, no contact sports for 6 months

Question 20

What investigation must be performed to diagnose adhesive capsulitis? What can it be mistaken for?

Answer 20

Radiograph- can be mistaken for OA or locked posterior dislocation

Question 21

What are the outcomes of adhesive capsulitis?

Answer 21

Generally good. Nearly all patients will have an extent of residual stiffness, and 15% will have residual pain

Question 22

Acute calcific tendonitis presents how?

Answer 22

Acute onset of severe shoulder pain

Question 23

What causes acute calcific tendonitis?

Answer 23

Calcium deposition in the suprspinatus tendon, just proximal to the greater tubercle

Question 24

What investigation can be used for acute calcific tendonitis?

Answer 24

x-ray

Question 25

What induces relief in the short term management of acute calcific tendonitis? Is there a specific treatment?

Answer 25

Subacromial steroid and local anaesthetic injection. Overall a self-limiting condition.