Frozen Shoulder: Difference between revisions
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== Definition/Description == | == Definition/Description == | ||
By definition, adhesive capsulitis is a benign, self-limiting condition of unknown etiology characterized by painful and limited active and passive glenohumeral range of motion of ≥ 25% in at least two directions <ref name="Dias">Dias R, Cutts S, Massoud S. Frozen shoulder. BMJ 2005; 331:1453-6.</ref> | By definition, adhesive capsulitis is a benign, self-limiting condition of unknown etiology characterized by painful and limited active and passive glenohumeral range of motion of ≥ 25% in at least two directions <ref name="Dias">Dias R, Cutts S, Massoud S. Frozen shoulder. BMJ 2005; 331:1453-6.</ref><ref name="Kelley">Kelley M, Mcclure P, Leggin B. Frozen shoulder: Evidence and a proposed model guiding rehabilitation. J Orthop Sports Phys Ther 2009;39:135-148.</ref><ref name="Brue">Brue S et al. Idiopathic adhesive capsulitis of the shoulder: a review. Knee Surg Sports Traumatol Arthrosc. 2007. 15:1048-1054.</ref><ref name="Cleland">Cleland J, Durall CJ. Physical therapy for adhesive capsulitis: Systematic review. Physiotherapy 2002;88:450-457.</ref><ref name="Bal" />most notably shoulder flexion and external rotation. | ||
Adhesive capsulitis, commonly referred to as frozen shoulder, is associated with synovitis and capsular contracture and can be classified as either primary or secondary <ref name="Dias" /> | Adhesive capsulitis, commonly referred to as frozen shoulder, is associated with synovitis and capsular contracture and can be classified as either primary or secondary <ref name="Dias" /><ref name="Kelley" /><ref name="Brue" /><ref name="Cleland" /><ref name="Bal" /><ref name="Walmsley">Walmsley S, Rivett DA, Osmotherly PG. Adhesive capsulitis: Establishing consensus on clinical identifiers for stage 1 using the delphi technique. Phys Ther 2009;89:906-917.</ref>. Frozen shoulder is considered primary if the onset is insidious while secondary is thought to be a result of another disease process. Three subcategories of secondary frozen shoulder include systemic (diabetes mellitus and other metabolic conditions), extrinsic (cardiopulmonary disease, cervical disc, CVA, humerus fractures, Parkinson’s disease), and intrinsic factors (rotator cuff pathologies, biceps tendonitis, calcific tendonitis, AC joint arthritis)<ref name="Kelley" />. | ||
In clinical practice it can be hard to differentiate adhesive capsulitis from other shoulder pathologies and it may be tempting to label any patient with a stiff, painful shoulder as a case of frozen shoulder. Since the physical therapy management of adhesive capsulitis is much different than that of other shoulder pathologies it can be detrimental to the patient if they are misdiagnosed. Therefore, it is important for the clinician to be aware of the ‘hallmarks’ of frozen shoulder and recognize the clinical phases that are specific to this condition <ref name="Dias" /> which are discussed below. <br> | In clinical practice it can be hard to differentiate adhesive capsulitis from other shoulder pathologies and it may be tempting to label any patient with a stiff, painful shoulder as a case of frozen shoulder. Since the physical therapy management of adhesive capsulitis is much different than that of other shoulder pathologies it can be detrimental to the patient if they are misdiagnosed. Therefore, it is important for the clinician to be aware of the ‘hallmarks’ of frozen shoulder and recognize the clinical phases that are specific to this condition <ref name="Dias" /> which are discussed below. <br> | ||
Revision as of 03:42, 15 November 2010
Original Editors - Dawn Waugh
Lead Editors - Sarah Grafelman,
Search Strategy[edit | edit source]
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Definition/Description[edit | edit source]
By definition, adhesive capsulitis is a benign, self-limiting condition of unknown etiology characterized by painful and limited active and passive glenohumeral range of motion of ≥ 25% in at least two directions [1][2][3][4][5]most notably shoulder flexion and external rotation.
Adhesive capsulitis, commonly referred to as frozen shoulder, is associated with synovitis and capsular contracture and can be classified as either primary or secondary [1][2][3][4][5][6]. Frozen shoulder is considered primary if the onset is insidious while secondary is thought to be a result of another disease process. Three subcategories of secondary frozen shoulder include systemic (diabetes mellitus and other metabolic conditions), extrinsic (cardiopulmonary disease, cervical disc, CVA, humerus fractures, Parkinson’s disease), and intrinsic factors (rotator cuff pathologies, biceps tendonitis, calcific tendonitis, AC joint arthritis)[2].
In clinical practice it can be hard to differentiate adhesive capsulitis from other shoulder pathologies and it may be tempting to label any patient with a stiff, painful shoulder as a case of frozen shoulder. Since the physical therapy management of adhesive capsulitis is much different than that of other shoulder pathologies it can be detrimental to the patient if they are misdiagnosed. Therefore, it is important for the clinician to be aware of the ‘hallmarks’ of frozen shoulder and recognize the clinical phases that are specific to this condition [1] which are discussed below.
Epidemiology /Etiology[edit | edit source]
Adhesive capsulitis has been reported to affect 2-3% of the general population and up to 30% of people with type II diabetes. It is more common in women aged 40-60. [6] While recurrence in the same shoulder is rare, contra-lateral shoulder involvement has been estimated between 20-30%.[3] Other identified risk factors include cervical disk disease, iimmobilization of the shoulder, cardiovascular disease, pulmonary disease, hyperthyroidism, and autoimmune diseases. [7]
Characteristics/Clinical Presentation[edit | edit source]
Patients may report progressive difficulty with dressing, grooming, and performing overhead activities. Literature describes adhesive capsulitis occuring in three overlapping phases. The first phase, the painful stage, involves painful shoulder motion and sleep being interrupted. The second state, the frozen or adhesive stage, is characterized by reduced pain and loss of joint motion. During the third stage, the resolution or thawing stage, pain is resolved and motion is gradually returned. [7][6] Adhesive capsulitis is thought to be self-limiting with the average recovery taking 3 years, though some authors report 50% of patients have pain or stiffness at 7 years. [3]
Differential Diagnosis[edit | edit source]
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Examination[edit | edit source]
Though there is no valid clinical diagnostic criteria for adhesive capsulitis, a recent study gathered the opinions of 70 experts in adhesive capsulitis. They came to the following conensus on characteristics of people with adhesive capsulitis.
- night pain
- increase pain with rapid or unguarded movement
- pain is aggravated by movement
- increased discomfort lying on affected side
- global loss of active and passive motion
- pain at end range in all directions
- generally age of onset is >35 years old. [6]
In addition, if radiographs are taken, they are typically normal. [3]
DASH (see Outcome Measures Database)
Medical Management (current best evidence)[edit | edit source]
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Physical Therapy Management (current best evidence)[edit | edit source]
Research has shown that joint mobilization and exercise increases the likelihood of successful outcomes. Passive range of motion improved with Matiland grade III or IV mobilizations and posteriorly directed Kaltenborn grade III mobilizations. Two pairs of interventions: iontophoresis and phonophoresis and ultrasound and massage, decreased the likelihood of significant improvement by 19-32%. [7]
Intraarticular corticosteroid injections are another treatment option. Random, controlled studies show injections with an exercise program improved pain and function scores at 2 weeks, but no difference at 12 weeks. Therefore, cotricosteroids help initially with pain and function during the first few weeks, but not in the long term. [5]
Baums et al analyzed 30 patient who had not improved with 6 months of conservative treatment. Following arthroscopic release, patients demonstrated improved range of motion, functional scores, and decreased pain. [8]
Key Research[edit | edit source]
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Resources
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Clinical Bottom Line[edit | edit source]
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Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
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- ↑ 1.0 1.1 1.2 Dias R, Cutts S, Massoud S. Frozen shoulder. BMJ 2005; 331:1453-6.
- ↑ 2.0 2.1 2.2 Kelley M, Mcclure P, Leggin B. Frozen shoulder: Evidence and a proposed model guiding rehabilitation. J Orthop Sports Phys Ther 2009;39:135-148.
- ↑ 3.0 3.1 3.2 3.3 3.4 Brue S et al. Idiopathic adhesive capsulitis of the shoulder: a review. Knee Surg Sports Traumatol Arthrosc. 2007. 15:1048-1054.
- ↑ 4.0 4.1 Cleland J, Durall CJ. Physical therapy for adhesive capsulitis: Systematic review. Physiotherapy 2002;88:450-457.
- ↑ 5.0 5.1 5.2 Bal A et al. Effectiveness of Corticosteroid Injection in Adhesive Capsulitis. Clinical Rehabiliation. 2008; 22:503-512.
- ↑ 6.0 6.1 6.2 6.3 Walmsley S, Rivett DA, Osmotherly PG. Adhesive capsulitis: Establishing consensus on clinical identifiers for stage 1 using the delphi technique. Phys Ther 2009;89:906-917.
- ↑ 7.0 7.1 7.2 Jewell DV et al. Interventions Associated With an Increased or Decreased Likelihood of Pain Reduction and Improved Function in Patients With Adhesive Capsulitis: A Retrospective Cohort Study. Physical Therapy. May, 2009. 89(5): 419-428.
- ↑ Baums MH et al. Functional Outcome and General Health Status in Patients after Arthroscopic Release in Adhesive Capsulitis. Knee Surg Sports Traumatol Arthrosc. 2007; 15:638-644.
