Cheatography
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Presentation, management, etc
This is a draft cheat sheet. It is a work in progress and is not finished yet.
Classification
Primary: No identifiable causes |
Secondary: More common, period of restricted shoulder motion (rotator cuff pathology, trauma, surgery) |
Can be caused by thyroid problems and diabetes (both types) - usually associated with poorer clinical outcome and recovery
- Female 55 years of age, non-dominant side
Stages
Stage 1: Achiness, sharpness at end range |
Stage 2: painful/freezing gradual, progressive loss of shoulder ROM lasting weeks to months |
Stage 3: frozen, pain and significant loss of ROM for 12-24 months |
Stage 4: thawing stage , progressive decrease in pain and stiffness can last up to 9 months |
Presentation
- Progressive pain either after an event (secondary) or came on suddenly (primary) |
- Pain focal to the deltoid with sharpness at end range |
- Night pain and sleep disturbances |
- Difficulty with overhead movements , behind the back or to the side |
- Loss of shoulder ROM (passive and active) in two or more planes of motion in the following order( external, abduction, internal rotation, forward flexion) |
- Atrophy of shoulder muscles may be present with no weakness |
- Look for scapula dyskinesis and shoulder hitching, upper crossed |
- CX spine restrictions can be found |
- Neurological exam unremarkable |
- Secondary AC can mimic rotator cuff pathology (+ve Hawkins Kennedy, Neers, Jobes, Speeds) |
Imaging
- Only to rule out other pathologies (OA/dislocation) |
- MRI to rule out Rotator cuff pathology/ no improvement with conservative care |
- MRI can show axillary recess thickening , joint volume reduction, rotator cuff interval thickening, synovitis |
- Arthroscopy |
Pathophysiology
- Inflammation in the joint capsule and synovial fluid
- Reactive fibrosis and adhesions of the synovial lining of the joint
- Athroscopy showing a normal shoulder (L) and subacromial fibrosis, proliferative synovitis and capsular thickening (R)
Ddx
- F# |
- Infection |
- Neoplasm |
- Calcific tendinitis |
- Bursitis |
- CX radioculopathy |
- Fibromyalgia |
- Shoulder impingement |
- Rotator cuff pathology |
- OA |
- systemic arthropathy |
- Sprain/strain |
- Referred scleratogenous (cardiac/digestive ) |
- PMR |
Management
- Active and passive stretching of shoulder capsule |
- Scapula mobilisation |
- CX and TX SMT |
- Passive shoulder exercises (cane and Torbay exercises) |
- Upper postural correction( upper crossed, scapula dyskenisis) |
- Heat/ice |
- Explain to patient that this recovery is a slow process and self limiting (most get better suddenly within 18-30 months) |
- Spencer technique |
- NSAIDs & Corticosteroids |
- Referral to orthopaedic surgeon if:
- Symptoms are not improving within 10-12 months with conservative care
- Steroids/ NSAIDs do not help
- No response to GH/SA injections |
- Surgery contraindications:
- Inadequate course of steroids/NSAIDs
- Patient has not undergone conservative care
- Acute infection
- Concomitant malignancy in the shoulder
- Neurological deficit/nerve complaint from the cx |
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