Adhesive capsulitis frozen shoulder Flashcards Preview

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Flashcards in Adhesive capsulitis frozen shoulder Deck (13):
1

Hx

57 yr old F 3 month hx R shoulder pain, not gotten worse, but hasn't settled despite painkillers, intermittent and aching pain, hard to wash/dress/sleep
DM1, on insulin, well controlled

2

look/ inspect

reduced muscle bulk r deltoid disuse atrophy

3

feel

no tenderness over r glenohumeral joint

4

active movement

reduced and painful ROM [ particularly lateral rotation followed by abduction followed by medial rotation]

5

passive movement

reduced and painful ROM [particularly lateral rotation followed by abduction followed by medial rotation]
resistant and painful end feel but no crepitus

6

DDx

adhesive capsulitis
rotator cuff pathology
gleno-humeral arthritis

7

why is adhesive capsulitis likely?

hx painful and stiff shoulder, hx of diabetes
exam reduced and painful active and passive ROM, no tenderness

8

why is rotator cuff pathology unlikely?

no tenderness
limited range of passive motion
no painful arc during active ROM
no pain on resisted movement

9

why is gleno-humeral osteoathritis unlikely?

slower onset of OA
not as painful at beginning
tenderness present also

10

GP investigations

X-ray shoulder for OA, calcific tendinitis
Bloods for FBC, ESR, CRP, rheumatoid screen
MRI rule out rotator cuff pathology

11

Ortho innvestigations

MR arthrogram
loss of axillary recess indicates contracture of joint capsule

12

Non-op tx

analgesia
physio
intra-articular steroids/LA
Refer to ortho

13

op tx

MUA
Arthroscopic release