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Frozen ShoulderAka: Shoulder Adhesive Capsulitis, Adhesive Capsulitis

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  1. Definition
    1. Shoulder Pain and limited range of motion stemming from disuse
  2. Epidemiology
    1. Age over 40 years
    2. Women more commonly affected
  3. Risk Factors
    1. Chronic Shoulder Pain (results in disuse)
      1. Bicipital Tenosynovitis
      2. Rotator Cuff Tendinitis
      3. Shoulder Band Syndrome (Reflex Sympathetic Dystrophy)
    2. Comorbid conditions that predispose to adhesive capsulitis
      1. Diabetes Mellitus
      2. Thyroid Disease
  4. Symptoms
    1. Gradual onset of decreased shoulder stiffness
    2. Pain onset after significant Shoulder Range of Motion lost
    3. Pain well localized to rotator cuff
    4. Pain radiation into deltoid and anterior arm
    5. Pain interferes with sleep (unable to lie on shoulder)
  5. Signs
    1. Inspection
      1. Patient holds arm protectively at side
      2. Deltoid and Supraspinatus atrophy
    2. Palpation
      1. Generalized pain at rotator cuff and biceps tendon
    3. Limited range of motion
      1. Loss of both active and passive Shoulder Range of Motion (pathognomonic)
      2. Loss of motion in all planes
      3. Normal range of motion excludes adhesive capsulitis as a diagnosis
    4. Associated Findings: Reflex Sympathetic Dystrophy
      1. Hand Edema, coolness, and discoloration
  6. Differential Diagnosis
    1. See Shoulder Pain
  7. Imaging: Shoulder XRay
    1. Typically normal in adhesive capsulitis
    2. Evaluate differential diagnosis
      1. Posterior Shoulder Dislocation
      2. Glenohumeral Osteoarthritis
  8. Management
    1. Conservative measures to relieve pain
      1. Rest
      2. Moist heat
      3. Sedation
      4. Analgesics
    2. Physical Therapy (Start as soon as possible)
      1. See Shoulder Range of Motion Exercises
      2. Initially, home Exercises are performed hourly
    3. Subacromial Corticosteroid Injection
      1. Indicated at 6 weeks for course refractory to conservative measures and physical therapy
      2. Restart Shoulder Range of Motion Exercises at 1 week after injection
      3. Ryans (2005) Rheumatology 44:529
    4. Surgical Intervention (rarely needed)
      1. Indicated at 6 months for course refractory to above measures
      2. Procedures
        1. Careful shoulder manipulation under general anesthesia
        2. Capsular release by shoulder arthroscopy
        3. Cervical Sympathetic Nerve blocks (used historically for refractory pain control)
  9. Prevention
    1. Maintain Shoulder Range of Motion at time of injury
    2. See Shoulder Range of Motion Exercises
  10. Course
    1. Insidious onset of pain
    2. Chronic, full recovery may take over 6 months
    3. Most regain near full motion of shoulder within 1-2 years even without intervention
  11. References
    1. Burbank (2008) Am Fam Physician 77:493
    2. Griggs (2000) J Bone Joint Surg Am 82-A:1398

Adhesive Capsulitis (C0158300)

ConceptsDisease or Syndrome (T047)
MSHD002062
EnglishAdhesive Capsulitides, Adhesive Capsulitis
SourcesDXP, MSH
Derived from the NIH UMLS (Unified Medical Language System)


Frozen shoulder (C0311223)

ConceptsDisease or Syndrome (T047)
ICD9726.0
EnglishADHESIVE CAPSULIT SHLDER, Adhesive capsulitis of shoulder, Adhesive capsulitis of the shoulder, Adhesive capsulitis shoulder, FROZEN SHOULDER, Pericapsulitis of shoulder
Spanishbursitis adherente, capsulitis adhesiva del hombro, capsulitis retractil, hombro rigido
Parent ConceptsPeripheral enthesopathies and allied syndromes (C1442902), Capsulitis NOS (C0263907), Shoulder joint inflamed (C0574943), Inflammatory disorder of extremity (C1285336), Disorder of shoulder (C1290859), Ambiguous concept (C1274012)
SourcesCOSTAR, DXP, ICD9CM, MTH, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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