Adhesive capsulitis: Difference between revisions
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==Management== | ==Management== | ||
*Avoid immobilization | *Avoid immobilization | ||
*PT | |||
*Analgesia | *Analgesia | ||
**[[NSAIDs]], [[opioids]] | **[[NSAIDs]], [[opioids]] | ||
*Oral steroids | *Oral steroids | ||
**Provide significant short-term benefit in terms of relieving pain and improving ROM | **Provide significant short-term benefit in terms of relieving pain and improving ROM | ||
*Intra-articular steroids (20-40mg triamcinolone) | |||
**Benefits last a few months, possibly up to 6 months<ref>Sun Y, Zhang P, Liu S, et al. Intra-articular Steroid Injection for Frozen Shoulder: A Systematic Review and Meta-analysis of Randomized Controlled Trials With Trial Sequential Analysis. Am J Sports Med. 2017;45(9):2171-2179.</ref> | |||
*Joint distention | |||
**Intra-articular distention with 25-40mL of saline + anesthetic is as effective as IA steroids<ref>Lin MT, Hsiao MY, Tu YK, Wang TG. Comparative Efficacy of Intra-Articular Steroid Injection and Distension in Patients With Frozen Shoulder: A Systematic Review and Network Meta-Analysis. Arch Phys Med Rehabil. 2018;99(7):1383-1394.e6.</ref> | |||
==Disposition== | ==Disposition== | ||
Revision as of 00:53, 15 June 2019
Background
- Also known as "frozen shoulder syndrome"
- Inflammation of glenohumeral joint → joint capsule fibrosis, shoulder restriction
- Must rule-out posterior shoulder dislocation
- Associated with:
- Impingement Syndrome
- Postmenopause
- DM
- Thyroid disease
- Pulmonary neoplasm
- Autoimmune
Clinical Features
- Stage 1 (first 2-3mo)
- Acute synovial inflammation with limitation of shoulder movement due to pain
- Stage 2 (months 3-9)
- "Freezing stage"
- Decreased shoulder motion due to capsular thickening/scarring; patient has chronic pain
- "Freezing stage"
- Stage 3 (months 9-15)
- "Frozen stage"
- Less pain, but significantly decreased range of motion
- "Frozen stage"
- Stage 4 (months >15)
- Minimal pain, progressive improvement in shoulder range of motion
Evaluation
- Hallmark is limited active and passive range of motion
- Pain
- Diffuse, aching, poorly localized, accompanied by stiffness, worse at night
- Not typically reproducible by palpation
Differential Diagnosis
Shoulder and Upper Arm Diagnoses
Traumatic/Acute:
- Shoulder Dislocation
- Clavicle fracture
- Humerus fracture
- Scapula fracture
- Acromioclavicular joint injury
- Glenohumeral instability
- Rotator cuff tear
- Biceps tendon rupture
- Triceps tendon rupture
- Septic joint
Nontraumatic/Chronic:
- Rotator cuff tear
- Impingement syndrome
- Calcific tendinitis
- Adhesive capsulitis
- Biceps tendinitis
- Subacromial bursitis
- Cervical radiculopathy
Refered pain & non-orthopedic causes:
- Referred pain from
- Neck
- Diaphragm (e.g. gallbladder disease)
- Brachial plexus injury
- Axillary artery thrombosis
- Thoracic outlet syndrome
- Subclavian steal syndrome
- Pancoast tumor
- Myocardial infarction
- Pneumonia
- Pulmonary embolism
Management
- Avoid immobilization
- PT
- Analgesia
- Oral steroids
- Provide significant short-term benefit in terms of relieving pain and improving ROM
- Intra-articular steroids (20-40mg triamcinolone)
- Benefits last a few months, possibly up to 6 months[1]
- Joint distention
- Intra-articular distention with 25-40mL of saline + anesthetic is as effective as IA steroids[2]
Disposition
- Refer to primary care for physical therapy
References
- ↑ Sun Y, Zhang P, Liu S, et al. Intra-articular Steroid Injection for Frozen Shoulder: A Systematic Review and Meta-analysis of Randomized Controlled Trials With Trial Sequential Analysis. Am J Sports Med. 2017;45(9):2171-2179.
- ↑ Lin MT, Hsiao MY, Tu YK, Wang TG. Comparative Efficacy of Intra-Articular Steroid Injection and Distension in Patients With Frozen Shoulder: A Systematic Review and Network Meta-Analysis. Arch Phys Med Rehabil. 2018;99(7):1383-1394.e6.