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MSK 1 > 9/20 - Adhesive Capsulitis > Flashcards

9/20 - Adhesive Capsulitis Flashcards

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1
Q

what is frozen shoulder a general term for

A

any shoulder condition consisting of pain and limited ROM

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2
Q

what is characteristic of frozen shoulder syndrome as a pathology or dx

A

self limiting

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3
Q

what is adhesive capsulitis

A

inflammatory reaction of the capsule and/or synovium that subsequently leads to formation of adhesions in the axillary fold of attachment of inferior capsule to anatomic neck

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4
Q

how does adhesive capsulitis impacts the arthrokinemetics of the shoulder joint

A

stops humerus from rolling inferiorly like it normally does
- the inferior/anterior capsule isn’t lax like it is supposed to

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5
Q

what is frozen shoulder characterized by

A

functional restriction of both AROM and PROM shoulder motion

radiographs of GH joint unremarkable other than possible presence of:
- osteopenia
- calcific tendinitis

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6
Q

how can adhesive capsulitis be classified

A

primary - insidious onset, no significant event or associated condition

secondary - identifiable event or associated condition which led to it

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7
Q

what are 3 causes of secondary frozen shoulder

A

intrinsic - at or in the shoulder

extrinsic - identifiable abnormality remote to shoulder itself

systemic - associated w systemic disorders

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8
Q

what are intrinsic causes of secondary frozen shoulder (3)

A

rotator cuff disorders
biceps tendinitis
calcific tendinitis

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9
Q

what are extrinsic causes of secondary frozen shoulder (7)

A

mastectomy
heart surgery
cervical radiculopathy
CVA
MI
humeral fx
AC arthritis

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10
Q

what are systemic causes for secondary frozen shoulder (3)

A

DM
hyper/hypothyroidism
hypoadrenalism

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11
Q

what stage of a frozen shoulder is marked by pain

A

stage 2 - acute adhesive, freezing

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12
Q

what causes the pain experienced in stage 2 frozen shoulder? describe the pain

A

angry red synovitis is what causes pain

bad a rest, worse w movement
- causes an empty end feel (can’t move to point of restriction d/t pain)

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13
Q

what is an important component of pt education when it comes to frozen shoulder

A

telling them its a long road

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14
Q

what are the 2 biggest risks/causes of frozen shoulder

A

insidious
DM

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15
Q

why is DM a commonly associated risk factor w adhesive capsulitis

A

hyperglycemia leads to inc in intermolecular cross-linkages in collagen

collagen is more resistant to degeneration and more likely to accumulate

collagen cross-links may also inc the stiffness of connective tissue

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16
Q

describe the pathology of adhesive capsulitis (7 steps)

A
  1. chronic capsular inflammation
  2. capsular fibrosis
  3. constrictive capsulitis
  4. adhesion of synovial folds and axillary recess
  5. obliteration of joint cavity
  6. formation of scar tissue where adhesions are
  7. thickened and contracted capsule becomes fixed to bone
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17
Q

what would a capsular pattern present as

A

ER > ABD > IR

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18
Q

what is diagnostic criteria (4)

A

capsular pattern
insidious onset, night pain
painful & limited A-PROM
normal radiographs

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19
Q

what is the key indicator for diagnosing adhesive capsulitis

A

ALL motion is limited

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20
Q

how does a pt present (not including pain) - 3

A

insidious onset
difficulty sleeping
motion restriction continues

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21
Q

acute vs frozen/thawing stage primary presentation

A

acute - pain primary complaint

frozen/thawing - significant limitations in mobility

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22
Q

how does a pt’s pain typically present

A

pain predominant early
- new n. growth in capsuloligamentous complex
- vague in deltoid area
- C5 distribution along lateral arm

pain on palpation (bicipital groove)

pain at rest subsides w progression

pain resolves spontaneously

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23
Q

what are the two biggest things seen in a physical exam for someone in the acute stage

A

high reactivity
empty end feel

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24
Q

why is ROM restricted in sub-acute/chronic stages

A

scarred adhesions

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25
how is joint play limited in sub-acute and chronic stages
limited throughout - inferior most limited - then anterior
26
what is the predominant feature noticed in a physical exam of sub-acute and chronic stages
motion restriction
27
how do the end feels vary in early freezing vs frozen/thawing
early freezing - empty end feel frozen/thawing - capsule/hard
28
what stage would a pt likely be in if they complain they can't sleep thru the night
acute freezing
29
if someone is in the freezing stage, what is an important education piece to provide about their sx
its going to get worse before it gets better
30
how are radiographs utilized in adhesive capsulitis
typically normal can r/o other path
31
what other path can radiographs r/o (5)
OA osteoporosis degenerative changes calcium deposits dec subacromial space
32
what are 7 differential dx to consider if suspect adhesive capsulitis
impingement syndrome rotator cuff lesion biceps tendinitis OA cervical radiculopathy neural tension medical complications
33
how can you differentiate between adhesive cap and impingement syndrome
impingement syndrome will have normal accessory glide at GH joint
34
how can you differentiate between a RC lesion and adhesive cap
RC lesion will have normal PROM and accessory glide at GH joint RC lesion will have pain w AROM w arm at side
35
how can you differentiate between biceps tendinitis and adhesive cap
biceps tendinitis will have normal accessory glide at GH joint
36
what differential dx is closely related to adhesive cap
biceps tendinitis - pain is present w both dx
37
how can you differentiate b/w OA and adhesive cap
OA will have (+) radiograph findings of spurring and dec joint space
38
what similarities do you see between OA and adhesive cap
pain and capsular pattern
39
how do you differentiate b/w cervical radiculopathy and adhesive cap
cervical radiculopathy will have sx reproducible w a cervical exam
40
what similarities do you see in the presentation of cervical radiculopathy and adhesive cap
similar pain in C5 distribution
41
how do you differentiate b/w neural tension and adhesive cap
neural tension is typically seen w trauma or repetitive stress
42
what medical complications could be presenting similar to adhesive cap (5)
heart lungs spleen gall bladder thyroid
43
how do you differentiate b/w adhesive cap and any other medical complications
medical complications will have an absence of mechanical findings
44
what is an important component in optimizing treatment
depends on recognition of clinical stage at presentation - condition will progress thru a predictable sequence
45
what are the 4 overall goals of treatment
dec pain dec inflammation education - how long healing can take restore capsular mobility
46
use of modalities in treatment
lack of evidence for efficacy - if anything might be helpful acutely - but rarely in your tx plan
47
what direction are mobilizations in typically
posterior and inferior - people already leaning forward and putting pressure on anterior capsule
48
why would mobilization of the posterior capsule be beneficial
posterior capsule restrictions prevent anterior movement of humeral head w ER
49
what are some mobilization techniques that can be utilized in treatment
distraction anterior posterior inferior combined movements - anterior and inferior - posterior and inferior
50
what patient would benefit to a combined motion of anterior-inferior mobilization
if pt has limited ER - can add ER to take up slack
51
what patient would benefit from a combined motion of posterior-inferior mobilization
if pt has limited IR - can add IR to take up slack
52
when is it ideal for interventions to be more aggressive
in frozen and thawing stages - aggressive interventions would make condition worse in freezing stage
53
what are benefits to a corticosteroid injection (3)
reduce pain and ms guarding faster initial relief of sx improved pain and ROM in initial 4wks
54
what plays a role in the efficacy of a corticosteroid injection
the earlier the better - more significant improvements in acute stage (2-6wks in studies) studies showing no difference at 12wks
55
what is the method to doing a manipulation under GA/brachial plexus block
short lever arm force into ABD while stabilizing scap followed by manip into ER and IR
56
what are complications to performing a manipulation under GA/brachial plexus block (5)
fx: glenoid, scap, humeral dislocation RC/labral tear hemarthrosis brachial plexus traction injury
57
who is a good candidate for a corticosteroid injection
high irritability cases
58
what pathology is characteristic of stage 1
synovial inflammation minimal or no loss of mobility
59
what pathology is characteristic of stage 2
synovitis early adhesions
60
what pathology is characteristic of stage 3
loss of axillary fold dec synovitis
61
what pathology is characteristic of stage 4
mature adhesions and motion restriction capsular end feel
62
what is the role of PT post-op an arthroscopic capsular release
daily pt - prevent scarring from coming back in
63
where do you see the arthroscopic capsular release anatomically
typically RC interval and coracohumeral ligament can release other shoulder ligaments and posterior capsule

MSK 1 (31 decks)

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