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CC Nov 2017 Adhesive Capsulitis

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echoecho's version from 2017-11-16 13:24

Section

Question Answer
Define?The combination of shoulder pain and loss of range of motion
Another name?Frozen shoulder
Etiology?Abnormal contraction of the glenohumeral joint capsule with adherence to the numeral head
Describe the pain? Range of motion?1)The pain is often insidious in onset, deep achy and poorly localized 2) loss of range of motion is NOT due to limitation from pain
Patients report difficulty reaching overhead or lifting the affected arm, true or false?true
What are the findings on physical exam?1) limitation of internal and external rotation 2) limition of abduction and forward flexion of the arm
Comparison with what often ad is in this assessment?the unaffected shoulder
Are signs of impingement (pain localized to the deltoid or lateral arm with overhead activity), constitutional symptoms (fever, weight loss) and radicular symptoms seen?no
Adhesive capsulitis is seen in what % of the population? What is it due to?1) 3% 2) due to shoulder injury and subsequent immobilization due to pain
It is more common what gender and in patients between what ages?1) women 2) 40-70 years
True or false? Symptoms in one shoulder increase the risk for disease in the other shoulder?true
For patients with primary adhesive capsulitis not related to trauma, list the risk factors that can cause this?1) diabetes mellitus (prevalence of 10-20%) 2) autoimmune disease 3) prolonged immobilization 4) thyroid disease
The pathophysiology of adhesive capsuilitis is not well understood although what conditions are seen?capsular fibrosis and hyperplasia
What role has been suggested in the pathophysiology?autoimmune role
List the 3 phases that are described in patients?1) painful 2) freezing 3) thawing
Why are these 3 phases somewhat arbitrary?as symptoms of pain and loss of motion may occur in all 3 stages and disease does not necessarily follow a linear course
How long may symptoms last and what % of patient may have persistent limitations of motion?1) several years 2) 10%
Physical exam can differentia adhesive capsulitis from other etiologies, explain?1) cervical spine arthritis may produce aching pain but no limitations of ROM 2) rotator cuff or acromioclavicular conditions may typically cause limitations due to pain but passive ROM is preserved 3) subacromial bursitis may present with a hx of repetitive overuse, but passive ROM will be preserved on exam similar to rotator cuff tendinopathy
What imaging test is diagnostic for adhesive capsulitis?there is none
Plain x-rays are used to r/ what?bony pathology
What can sometimes be seen on MRI, but this is neither pathognomonic for the condition nor necessary for dx?capsular thickening
A diagnostic injection of the subacromial bursa may aid the evaluation of what 2 conditions?1) subacromial bursitis OR 2) rotator cuff tendinopathy
*** Treatment?1) analgesics 2) physical therapy (although evidence is lacking for the long-term benefit of these options) 3) NSAIDS or acetaminophen 4) tapering courses of oral prednisone have been shown to provide short-term pain relief and improved ROM. 5) intra-articular steroid injections have been shown better results in short-term pain control and improvement in ROM than oral prednisone, but neither treatment shows benefit beyond 6 weeks
Are there any good quality studies that assess the benefits of physical therapy when compared to medical therapy?no
When is surgery used?for patients who fail conservative therapy, includes joint manipulation and surgical capsule release
*** SUMMARY = What causes adhesive capsulitis?"frozen shoulder" results from abnormal contraction of the glenohumeral joint capsule with adherence to the humeral head
*** SUMMARY = Treatment?analgesics and physical therapy (evidence is lacking for long-term benefit of these treatment options
*** SUMMARY = What oral medication has been shown to provide short-term pain relief and improved ROM?oral prednisone
*** SUMMARY = What treatment has been shown to have better results in short-term pain control and improvement of ROM than oral prednisone, but neither treatment shows benefit beyond 6 weeks?intra-articular steroid injections
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