MSK clinical application- adhesive capsulitis of the shoulder

Question 1

what is adhesive capsulitis also known as?

Answer 1

frozen shoulder

Question 2

adhesive capsulitis is characterized by __ and __ __ of the __ joint capsule of the shoulder

Answer 2

inflammation; fibrotic thickening
anterior

Question 3

once the anterior joint capsule of the shoulder becomes inflamed, what happens structurally?

Answer 3

the inflamed capsule becomes adherent to the humeral head via fibrous adhesions and thickens, undergoing contracture

Question 4

anterior joint capsular adhesion to the humeral head and thickening leads to a __ in space within the anterior joint capsule, causing a decrease __ __ and further __ to the GHJ

Answer 4

decrease; synovial fluid; irritation

Question 5

how is adhesive capsulitis classified?

Answer 5

primary or secondary

Question 6

how does primary adhesive capsulitis occur?

Answer 6

occurs spontaneously

Question 7

how does secondary adhesive capsulitis occur?

Answer 7

as a result of an underlying condition

Question 8

does primary adhesive capsulitis have a known etiology?

Answer 8

no

Question 9

what conditions (3) is primary adhesive capsulitis associated with?

Answer 9

diabetes mellitis
thyroid abnormalities
cardiopulmonary conditions

Question 10

what can secondary adhesive capsulitis result from (6)?

Answer 10

trauma
immobilization
complex regional pain syndrome
rheumatoid arthritis
abdominal disorders
psychogenic disorders

Question 11

what classification of adhesive capsulitis is associated with diabetes mellitus, thyroid abnormalities and/or cardiopulmonary conditions?

Answer 11

primary

Question 12

what classification of adhesive capsulitis can result from trauma, immobilization, CRPS, RA, abdominal disorders and psychogenic disorders?

Answer 12

secondary

Question 13

what orthopedic intrinsic disorders (3) may initiate the process of adhesive capsulitis?

Answer 13

supraspinatus tendonitis
partial rotator cuff tear
bicipital tendonitis

Question 14

what is adhesive capsulitis clinically characterized by?

Answer 14

restricted active and passive range of motion at the GHJ

Question 15

what are the characteristics of the acute phase of adhesive capsulitis?

Answer 15

pain radiating below the elbow and awakens the patient at night
limited shoulder PROM due to pain and guarding

Question 16

what are the characteristics of the chronic phase of adhesive capsulitis?

Answer 16

pain is typically localized around the lateral brachial region
patient is not awakened by pain at night
shoulder PROM is limited due to capsular stiffness
pain is present with a loss of glenohumeral motion, restricted elevation and lateral rotation

Question 17

what phase of adhesive capsulitis is characterized by pain that radiates below the elbow, awakening the patient at night and restricted shoulder PROM due to pain and guarding?

Answer 17

acute

Question 18

what phase of adhesive capsulitis is characterized by pain present around the lateral brachial region, lack of night pain, restricted shoulder PROM due to capsular stiffness and pain present with loss of glenohumeral motion, shoulder elevation and ER?

Answer 18

chronic

Question 19

what type of diagnostic imaging assists with the diagnosis of adhesive capsulitis?

Answer 19

an arthrogram

Question 20

a detection of a __ fluid volume within the joint capsule on an arthrogram would be indicative of adhesive capsulitis

Answer 20

decreased

Question 21

how much fluid, in ml, does the GHJ normally hold?

Answer 21

16-20 ml

Question 22

how much fluid is present in ml in the GHJ in a patient with adhesive capsulitis and subsequently decreased capsular size?

Answer 22

5-10 ml

Question 23

what shoulder planes of motion are typically affected in adhesive capsulitis?

Answer 23

all planes of motion

Question 24

in what planes of motion may a patient with adhesive capsulitis present with the greatest restriction of glenohumeral motion?

Answer 24

abduction and external rotation

Question 25

where might tightness be noted upon examination of an individual with adhesive capsulitis?

Answer 25

within the anterioinferior joint capsule

Question 26

what components of the subjective history are important to document when evaluating a patient with adhesive capsulitis?

Answer 26

PMH surgical history medications family history current symptoms current health status social history/habits occupation leisure activities social support system

Question 27

what tests and measures (12) are most appropriate/important to include when initially evaluating/treating a patient with adhesive capsulitis?

Answer 27

anthropometrics: circumferential measurements of the BUE arousal, attention, cognition: examine mental status, learning ability, memory and motivation cranial nerve integrity: assessment of muscle innervation by the cranial nerves, dermatomal assessment pain: pain perception assessment scale, visual analogue scale, assessment of muscle soreness posture: resting and dynamic A/PROM muscle performance: strength assessment, muscle tone assessment integumentary integrity: skin assessment, sensation assessment joint integrity and mobility: assessment of hyper/hypomobility, soft tissue swelling and inflammation self-care and home management: assessment of functional capacity environmental, home and work barriers community and work integration

Question 28

what additional findings/impairments are likely found in a patient with adhesive capsulitis?

Answer 28

muscle spasming around the shoulder secondary to muscle guarding loss of reciprocal arm swing disuse muscle atrophy

Question 29

a thorough examination of a patient with adhesive capsulitis must be completed in order to to rule out what 5 types of concomitent disorders?

Answer 29

systemic rheumatologic inflammatory metastatic infectious

Question 30

what pharmacological interventions should be used for adhesive capsulitis? what should pharmacological interventions for adhesive capsulitis emphasize?

Answer 30

should emphasize pain control through acetaminophen or longer acting analgesics, NSAIDs or narcotics

Question 31

a physician may inject the shoulder with __ to assist in recovery of motion in patients with adhesive capsulitis?

Answer 31

corticosteroids

Question 32

when should surgical intervention for adhesive capsulitis be considered?

Answer 32

as a last resort option and when conservative management has failed

Question 33

what is the goal of surgical intervention for adhesive capsulitis?

Answer 33

to break up adhesions or release muscles adhered to the capsule

Question 34

what interventions (6) should physical therapy during the acute phase of adhesive capsulitis include?

Answer 34

ice or superficial heat gentle joint mobilization progressive strengthening pendulum exercises isometric strengthening

Question 35

what interventions (4) should physical therapy during the chronic phase of adhesive capsulitis include?

Answer 35

US grade III and IV mobilizations increasing joint capsule extensibility techniques like PNF to restore painless, functional ROM

Question 36

during what phase of adhesive capsulitis should interventions like ice/heat, pendulums, gentle joint mobilizations and isometric/progressive strengthening be implemented?

Answer 36

acute phase

Question 37

during what phase of adhesive capsulitis should interventions like ultrasound, grade III and IV mobilizations and PNF techniques be implemented?

Answer 37

chronic phase

Question 38

a home exercise program during the acute phase of adhesive capsulitis should include some __ __, but avoid __ secondary to the risk of subacromial tissue damage

Answer 38

self-stretching; abduction

Question 39

self stretching should be included in the home exercise program of a patient in the acute phase of adhesive capsulitis, but should avoid abduction, why?

Answer 39

due to the risk of subacromial tissue damage

Question 40

a home exercise program during the chronic phase of adhesive capsulitis should emphasize what 5 things to assist in improving ROM?

Answer 40

self stretching progressive exercises posture management PNF techniques exercises like pendulums and wall climbs

Question 41

when is physical therapy for adhesive capsulitis typically prescribed in relation to initial dx?

Answer 41

typically prescribed 3-5 months after initial dx

Question 42

adhesive capsulitis usually follows a __-__ pattern of recovery

Answer 42

non-linear

Question 43

spontaneous recovery from adhesive capsulitis is said to take __-__ months

Answer 43

12-24

Question 44

although most patients are able to fully recover overtime from adhesive capsulitis, a small percentage of patients experience permanent loss of ROM at the shoulder joint that is frequently __ in nature and does not typically impair __

Answer 44

asymptomatic; function

Question 45

what differential diagnosis should be considered when evaluating a patient with suspected adhesive capsulitis?

Answer 45

acute subacromial bursitis

Question 46

what is acute subacromial bursitis characterized by?

Answer 46

intense, sometimes throbbing pain over the lateral brachial region of the shoulder

Question 47

subacromial bursitis may arise secondary to what condition?

Answer 47

calcific tendonitis (often of the rotator cuff tendons and most frequently the supraspintaus tendon)

Question 48

how can calcific tendonitis of the rotator cuff tendons result in subacromial bursitis?

Answer 48

calcium deposits in the tendons irritate or impinge on the subacromial bursa

Question 49

which rotator cuff tendon is most often affected by calcific tendonitis and involved in subacromial bursitis?

Answer 49

supraspintaus tendon

Question 50

during acute subacromial bursitis, pain limits what types and directions of motion?

Answer 50

pain limits active and passive motion in all directions

Question 51

in acute subacromial bursitis, shoulder __ greater than __ degrees and shoulder __ greater than __ degrees usually produces severe pain

Answer 51

shoulder abduction greater than 60 deg shoulder flexion greater than 90 deg

Question 52

acute subacromial bursitis typically lasts for __ __ __ and, unlike adhesive capsulitis, usually resolves itself within __ __ __

Answer 52

a few days; a few weeks

Question 53

A 53 year old female fell off her bike six months ago while cycling in a road race and sustained an injury to her shoulder complex. She attempted to immobilize her arm in a sling for two weeks and was unable to regain functional motion in her shoulder once she stopped using the sling. She is currently limited to 10 deg of ER and 95 degrees of shoulder flexion. What condition are her signs and symptoms most consistent with? what words within the question lead you to this condition/dx?

Answer 53

adhesive capsulitis key words w/in question: age, gender, traumatic MOI, immobilization in sling, limited shoulder ROM