Adhesive capsulitis: Difference between revisions
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**Diffuse, aching, poorly localized, accompanied by stiffness, worse at night | **Diffuse, aching, poorly localized, accompanied by stiffness, worse at night | ||
**Not typically reproducible by palpation | **Not typically reproducible by palpation | ||
==Differential Diagnosis== | |||
{{Shoulder DDX}} | |||
==Treatment== | ==Treatment== | ||
Revision as of 05:22, 18 February 2015
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 w/ limitation of shoulder movement due to pain
- Stage 2 (months 3-9)
- "Freezing stage"
- Decreased shoulder motion due to capsular thickening/scarring; pt 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
Diagnosis
- 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
Treatment
- Avoid immobilization
- Analgesia
- NSAIDs, opioids
- Oral steroids
- Provide significant short-term benefit in terms of relieving pain and improving ROM
Disposition
- Refer to PMD for physical therapy
Source
- Tintinalli