Adhesive Capsulitis

Question 1

What’s the most common cause of adhesive capsulitis?

Answer 1

Idiopathic

Question 2

What are risk factors for adhesive capsulitis?

Answer 2

Age (40-60)
Sex (female d/t hormonal changes)
DM (10-20%)
Smoking
Thyroid dx (cytokine-induced fibroblast proliferation)
Hypertension
Autoimmune dx
PD and HIV tx

Question 3

What is the pathological aspect of adhesive capsulitis? Why does fibrosis or scarring occur?

Answer 3

Insult(s) cause inflammation that leads to adhesive fibrosis and scarring (connective tissue growth) between the inflamed joint capsule of the GH joint and surrounding RC, subacromial bursa, and deltoid muscle > thickening and contracture of tissues that reduce ROM and joint volume

Fibrosis and scarring occurs because the joint capsule doesn’t heal well, inflammation also induces rapid tissue formation

Question 4

What do you find on PE for adhesive capsulitis?

Answer 4

Pt will have poor active ROM that’s reproducible with passive ROM (RCT will have non-restricted passive ROM)

Question 5

What ranges of motion are most commonly affected by AC/FS?

Answer 5

Abduction

External rotation

Question 6

What movements (not ROM) are often restricted in AC/FS?

Answer 6

Limited reaching and rotation

Question 7

Does imaging assist the diagnosis of AC/FS?

Answer 7

Can be used to rule out other dx (like arthritis)

- MRI is not typical standard of care

Question 8

What’s a differential for AC/FS?

Answer 8

RC tendonopathy
Subacromial bursitis
Impingement syndrome
Degenerative disc dx of c-spine/referred pain from neck
Apical lung CA

Question 9

What are the treatment recommendations?

Answer 9

Conservative tx for 1 yr (PT): 90% efficacy

• tylenol or nsaids
• rom stretches, pendulum swing, strength exercises
• glucocorticoid injections (methylprednisone)

Surgery:

• manipulation under anesthesia (MUA)
• arthroscopic capsular release (abnormal tissue cut or shaved and removed releasing the contractures)
• therapy treatment begins next day, happens every day for 2w along with home CPM (continuous passive motion) use, NSAID use ok (not a repair)

Question 10

What are the risks associated with MUA?

Answer 10

Humeral fractures

Brachial plexus injury

Question 11

What structures are to be avoided during AC/FS arthroscopic surgery?

Answer 11

Axillary n, thoraco-acromial a (deltoid and acromial branches), cephalic v, msculocutaneous n

Question 12

What are the risks of arthroscopic surgery?

Answer 12

Infection, stiffness, pain, neurovasc injury, DVT, failed repair