Adhesive capsulitis (frozen shoulder) Flashcards
1
Q
What is adhesive capsulitis?
A
Painful inflammatory process with thickening and contracture of the glenohumeral capsule
2
Q
Epidemiology of adhesive capsulitis?
A
- Uncommon but more common in middle aged women
- 20% are bilateral
- Metabolic syndrome implicated (20% of diabetics have one at some point)
3
Q
Aetiology of adhesive capsulitis?
A
- Primary: idiopathic
- Secondary: can follow trauma, hemiplegia, chest surgery or MI
4
Q
What are the 3 phases of adhesive capsulitis?
A
1) Acute/freezing/painful
2) Adhesive/frozen/stiff
3) Resolution
5
Q
Describe the acute/freezing/painful stage of adhesive capsulitis?
A
- Insidious onset of vague dull pain at deltoid insertion that becomes sharp with movement
- Nagging pain at night (patients can’t sleep on affected side)
- Progressive limitation of shoulder movement (especially external rotation)
- Lasts 3-9 months
6
Q
Describe the adhesive/frozen/stiff phase of adhesive capsulitis?
A
- Pain gradually replaced by stiffness (but still present at extremes of motion)
- Shoulder movement reduced actively and passively
- Struggle with ADLs (e.g. putting on coat)
- Lasts up to a year
7
Q
Describe the resolution phase of adhesive capsulitis?
A
- Spontaneous progressive improvement
- Contralateral shoulder can be affected years after
8
Q
What are the examination findings for adhesive capsulitis?
A
- Looks normal (may have scapula winging)
- May have tenderness over deltoid insertion and shoulder capsule on deep palpation
- Reduced active and passive movement (external rotation affected most)
9
Q
What is the investigation for frozen shoulder?
A
X-ray is diagnostic as it rules out OA, tumours and dislocation
10
Q
What are the main differentials for frozen shoulder?
A
- OA of glenohumeral joint
- Glenohumeral bursitis
- Rotator cuff injury
11
Q
What is the management of frozen shoulder?
A
- Rest and NSAID analgesia in pain phase
- Intra-articular steroids, and physiotherapy in the adhesive stage
