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  • Frozen shoulder syndrome

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  • 726.0 Adhesive capsulitis of shoulder

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  • M75.00 Adhesive capsulitis of unspecified shoulder

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Description

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  • Self-limiting shoulder pain and dysfunction due to:
    • Localized inflammation of glenohumeral joint capsule
    • Paucity of synovial fluid
    • Fibrosis of capsule causing adherence to humeral head
  • Three pathological pathways
    • Primary (idiopathic)
    • Secondary: can be attributed to a known intrinsic, extrinsic, or systemic cause
    • Tertiary: postoperative or post-fracture
  • Adhesive capsulitis (AC) can be divided into 4 stages
    • Stage 1: “Pre-adhesive”
      • Near normal range of motion, pain at end points of motion and mild synovitis
    • Stage 2: “Freezing”
      • Marked loss of motion, pain at end points with thickened read synovitis
    • Stage 3: “Frozen”
      • Marked loss of motion, painless range of motion with capsule fibrosis and adhesions
    • Stage 4: “Thawing”
      • Improved glenohumeral motion, painless range of motion; no synovitis present

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Essentials of Diagnosis

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  • Extrinsic factors
    • Cardiopulmonary disease
    • Cervical disc
    • CVA
    • Humerus fractures
    • Parkinson’s disease
  • Intrinsic factors
    • Dupuytren’s disease
    • Rotator cuff tendinitis
    • Rotator cuff tears
    • Biceps tendinitis
    • Calcific tendinitis
  • Systemic factors
    • Diabetes mellitus
    • Hypothyroidism
    • Hyperthyroidism
    • Hypoadrenalism
    • Dupuytren’s disease

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Demographics

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  • Affects 2 to 5% of the general population
  • Affects 10 to 38% of patients with thyroid disease or diabetes mellitus
  • Primary AC generally affects individuals aged 40-65 years
  • Greater incidence in females than males
  • Occurrence in one shoulder increases the risk of contralateral shoulder involvement 5 to 34%

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Signs and Symptoms

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  • Pain in anterior lateral shoulder described as achy at rest and sharp with end-range motion
  • Symptoms typically present for < 3 months if stage 1
  • Nighttime pain and pain when reaching behind the back are common
  • Active and passive ROM are equally limited

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Functional Implications

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  • Pain/limitation with overhead activities
  • Pain/limitation with reaching
  • Pain/limitation with lifting
  • Pain/limitation while dressing
  • Pain/limitation with sustained or repetitive shoulder activities
  • Pain at night disrupting sleep

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Possible Contributing Causes

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  • Degenerative changes at the acromioclavicular (AC) joint
  • Rotator cuff tendinopathy
  • Bicipital tendinopathy
  • Humeral fracture
  • Capsular tightness
  • Increased thoracic kyphosis and sub-optimal posture
  • History of trauma
  • Diabetes mellitus
  • Treatment with antiretroviral therapy

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Differential Diagnosis

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  • Cervical radiculopathy
  • Referred pain from lungs or diaphragm
  • Full-thickness rotator cuff tear
  • Glenohumeral arthritis
  • Glenohumeral contracture
  • Labral tear
  • Subacromial impingement
  • Neuropathy (suprascapular nerve)
  • Internal impingement

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Imaging

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  • Radiograph
    • Glenohumeral joint space
    • OA
    • Allows for secondary causes to be viewed
    • Views: AP, axillary lateral, scapular Y-view
  • MRI
    • Not required to make the diagnosis of adhesive capsulitis
    • Usually will demonstrate decreased hydration
    • Tissue quality
    • Capsulolabral and biceps labral pathology

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Diagnostic Procedure

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  • Sub-acromial injection with lidocaine: if pain decreases and motion improves, cuff pathology is present

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Medication

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