|
Year |
2005 |
|---|---|
|
Question Number |
5. |
|
Category |
Shoulder and Elbow |
Question
Recalcitrant idiopathic adhesive capulitis of the shoulder has been associated with
1- male gender.
2- diabetes mellitus.
3- renal insufficiency.
4- fibromyalgia.
5- menopause.
Figures
Answer (click for answer)
PREFERRED RESPONSE: 2
Patient with diabetes mellitus are a higher risk of adhesive capsulitis compared to the general population. It can be bilateral, and is resistant to all forms of treatment. Other risk factors include CV disease and neurologic conditions. It typically occurs in association with prolonged immobilization.
The Griggs paper referenced discusses patient outcomes for frozen shoulder following a stretching/physical therapy programs. Male gender and diabetes mellitus resulted in a worse outcome following this stretching program.
The Warner paper is a nice review of the etiology and various treatment options, and mentions diabetes mellitus as a risk factor for resistant adhesive capsulitis.
Adhesive capsulitis or ‘frozen shoulder’ causes limited range of motion of the glenohumeral joint due to soft-tissue contracture and scarring.
There may be a decreased space in the normal axillary recess seen on arthrography.
Three clinical stages:
1) Painful – gradual onset of diffuse pain
2) Stiff – decreased ROM, affects ADLs
3) Thawing – gradual return of motion
Three arthroscopic stages:
1) Patchy fibrinous synovitis
2) Capsular contraction, fibrinous adhesions, synovitis
3) Increased contraction, resolving synovitis
4) Severe contraction
Adhesive capsulitis may be primary (idiopathic) or post-traumatic/post-surgical. Primary is usually treated conservatively. Post-traumatic/post-surgical may require more aggressive treatment with supervised physical therapy, closed manipulation, arthroscopic release or open release.
Reference: RECOMMENDED READINGS: Wolf JM, Green A: Influence of comorbidity on self-assessment instrument scores of patients with idiopathic adhesive capsulitis. J Bone Joint Surg Am 2002;84:1167-1173.
Griggs SM, Ahn A, Green A: Idiopathic adhesive capsulitis: A prospective functional outcome study of nonoperative treatment. J Bone Joint Surg Am 2000;82:1398-1407.
Warner JJ: Frozen shoulder: Diagnosis and management. J Am Acad Orthop Surg 1997;5:130-140.