Stiff Shoulder

common causes of stiff shoulder

adhesive capsulitis, glenohumeral osteoarthritis

pathoanatomy of adhesive capsulitis

increased cytokine expression, synovial hyperplasia, new blood flow and nerve growth to area, increased collagen and fibroblast

where does adhesive capsulitis start

rotator cuff interval

ROM limitations in adhesive capsulitis

ER at 0 > abd > IR

ligaments that make up the rotator cuff interval

SGHL and coracohumeral

motions limited by rotator cuff interval

inferior and anterior translation of humeral head, ER at 0

motions limited by the MGHL

anterior translation of head at 60 degrees of abduction, ER at 45-60 degrees of abduction

motions limited by the IGHLC

anterior/posterior/inferior translation of head at 90 degrees of abduction

risk factors of adhesive capsulitis

female, 40-65 y.o., diabetes, thyroidism, duputryen, obesity, prolonged immobilization

main risk factor for frozen shoulder

diabetes

how does diabetes impact frozen shoulder outcomes

longer course, worse outcomes

typical clinical course of frozen shoulder

painful (0-3 mo), freezing (3-9 mo), frozen (9-15 mo), thawing (15-48 mo)

symptoms during painful stage of frozen shoulder

pain at rest, disturbs sleep, sharp pain at end ranges, misidentified as RTC related

symptoms during freezing stage of frozen shoulder

gradual loss of AROM likely from pain, sleep disturbance still present, aggressive synovitis

symptoms during frozen stage of frozen shoulder

progressive loss of motion, mobility deficits, capuloligamentous fibrosus

symptoms during thawing stage of frozen shoulder

significant stiffness with reducing pain

clinical course of frozen shoulder

a continuum of pathology characterized by a staged progression of pain and mobility deficits

how can we help with adhesive capsulitis

muscle, fear, and other impairments contribute to loss of ROM and we can treat them

what is stiffness associated with in adhesive capsulitis

contraction of the GHJ capsule

secondary causes of frozen shoulder

surgery, fracture, diabetes

what will be seen in a mobility assessment of frozen shoulder

very firm end feel, hypomobility of GHJ, ER less than 30 at 0 deg

how is imaging used in frozen shoulder diagnoses

to rule out OA

imaging findings of frozen shoulder

thickened anterior capsule, coracohumeral ligament thickening, RTC interval synovitis

symptoms of GH OA

pain, stiffness, feels clunky when moving

how to rule out adhesive capsulitis

PROM is normal, radiographic evidence of OA, ER/IR increases as the arm is abducted

primary GHJ OA

more common in elderly

secondary GHJ OA

more common in younger people due to previous condition or trauma

CPG recommendations for management of GHJ OA

no one specific intervention is superior to another

other reasons for shoulder stiffness

osteosarcoma, locked posterior dislocation of humeral head, avascular necrosis

adhesive capsulitis treatment

injection, stretching, manuals, manips, hydrodilation, surgery

length of effect of corticosteroids

12 weeks and up to 24

contraindication of corticosteroid injection

diabetes

translational manipulation for adhesive capsulitis

done under anesthesia to push through scar tissue and capsular tightening (done after 7 mo)

surgery done for adhesive capsulitis

capsular release of GHJ (RTC interval and coracohumeral ligament)

modalities for higher irritability

heat, TENS

stretching techniques

contract-relax, STM/stretching, modality/stretching

examples of AAROM

stick/dowel, doorway, pulley, band