adhesive capsulitis (frozen shoulder)

Question 1

Who does frozen shoulder most commonly affect?

Answer 1

• middle aged people

- diabetics

Question 2

what are the causes of adhesive capsulitis?

Answer 2

primary- occuring spontaneously without a trigger

secondary- occuring in response to trauma, surgery or immobilisation

Question 3

what joint does adhesive capsulitis affect?

Answer 3

glenohumeral

Question 4

what type of joint is the glenohumeral joint?

Answer 4

ball and socket (synovial)

Question 5

what is the pathophysiology behind adhesive capsulitis?

Answer 5

• the glenohumeral joint is surrounded by connective tissue that forms the joint capsule
• inflammation and fibrosis in the joint capsule lead the adhesion (scar tissue). The adhesion bind the capsule and cause it to tighten around the joint, restricting movement in the joint

Question 6

how does adhesive capsulitis tend to present?

Answer 6

it tends to present in 3 phases:

Painful phase- shoulder pain is often the first symptoms and may be worst at night

Stiff phase- shoulder stiffness develops and affects both active and passive movement, external rotation is most affected, and the pain settles down

Thawing phase- there is a gradual improve in stiffness and a return to normal

Question 7

how long can this take to self resolve?

Answer 7

1-3 years (roughly 6 months in each phase)

up to 50% of patients have persistent symptoms

Question 8

what are the investigations for frozen shoulder?

Answer 8

USS, CT or MRI could show thickened capsule
-Xrays usually normal
CLINICAL!!

Question 9

what is the treatment for frozen shoulder?

Answer 9

• analgesia
• physio
• steroid injections

Surgery:
-arthroscopy or manipulation under anaesthesia (for particularly resistant or severe cases)