Adhesive capsulitis - Revision history

Rossdonaldson1: /* Clinical Features */

2025-03-19T17:02:40Z

Clinical Features

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	**Not typically reproducible by palpation		**Not typically reproducible by palpation

	*Stage 1 ~~(first~~ 2-~~3mo)~~		{\| class="wikitable"
	**Acute synovial inflammation with limitation of shoulder movement due to pain		! Stage !! Category !! Timeline (months) !! Findings
	*Stage 2 ~~(months~~ 3-9)		\|-
	**"Freezing stage"		\| 1 \|\| Acute \|\| 2-3 \|\| Acute synovial inflammation with limitation of shoulder movement due to pain
	~~***~~Decreased shoulder motion due to capsular thickening/scarring; patient has chronic pain		\|-
	*Stage 3 ~~(months~~ 9-15)		\| 2 \|\| Freezing \|\| 3-9 \|\| Decreased shoulder motion due to capsular thickening/scarring; patient has chronic pain
	**"Frozen stage"		\|-
	~~***~~Less pain, but significantly decreased range of motion		\| 3 \|\| Frozen \|\| 9-15 \|\| Less pain, but significantly decreased range of motion
	*Stage 4 ~~(months~~ >15)		\|-
	**Minimal pain, progressive improvement in shoulder range of motion		\| 4 \|\| Chronic \|\| >15 \|\| Minimal pain, progressive improvement in shoulder range of motion
			\|}

	==Evaluation==		==Evaluation==

Rossdonaldson1: /* Disposition */

2025-03-19T16:38:48Z

Disposition

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	==Disposition==		==Disposition==
	*Discharge, refer to primary care/ortho for physical therapy		*Discharge, refer to primary care/ortho for physical therapy

			==See Also==
			*[[Shoulder diagnoses]]

			==External Links==

	==References==		==References==

Rossdonaldson1: /* Background */

2025-03-19T16:26:18Z

Background

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	==Background==		==Background==
			[[File:Gray326.png\|thumb\|Shoulder anatomy]]
			[[File:Shoulder_joint_back-en.png\|thumb\|Shoulder anatomy, anterior.]]
			[[File:Shoulder joint back 05r4v.png\|thumb\|Shoulder anatomy, posterior.]]
	*Also known as "frozen shoulder syndrome"		*Also known as "frozen shoulder syndrome"
	*Inflammation of glenohumeral joint → joint capsule fibrosis, shoulder restriction		*Inflammation of glenohumeral joint → joint capsule fibrosis, shoulder restriction

Rossdonaldson1: /* Management */

2025-03-19T16:25:23Z

Management

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	[[File:MRI. Thickened joint capsule, specially at the inferior recess. Could be a sign for a frozen shoulder..jpg\|thumb\|Shoulder MRI showing a thickened joint capsule, especially at the inferior recess, which can be a sign of adhesive capsulitis.]]		[[File:MRI. Thickened joint capsule, specially at the inferior recess. Could be a sign for a frozen shoulder..jpg\|thumb\|Shoulder MRI showing a thickened joint capsule, especially at the inferior recess, which can be a sign of adhesive capsulitis.]]
	*Avoid immobilization		*Avoid immobilization
	*PT		*Physical therapy
	*[[Analgesia]]		*[[Analgesia]]
	**[[NSAIDs]], [[opioids]]		**[[NSAIDs]], [[opioids]]

Rossdonaldson1: /* Management */

2025-03-19T16:25:04Z

Management

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	==Management==		==Management==
			[[File:MRI. Thickened joint capsule, specially at the inferior recess. Could be a sign for a frozen shoulder..jpg\|thumb\|Shoulder MRI showing a thickened joint capsule, especially at the inferior recess, which can be a sign of adhesive capsulitis.]]
	*Avoid immobilization		*Avoid immobilization
	*PT		*PT

ClaireLewis: /* Evaluation */

2019-10-18T17:12:37Z

Evaluation

← Revisión anterior		Revisión del 17:12 18 oct 2019
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	==Evaluation==		==Evaluation==
	*Clinical diagnosis, consider X-ray to rule out [[fracture]]/[[~~joint~~ dislocation\|dislocation]]		*Clinical diagnosis, consider X-ray to rule out [[fracture]]/[[shoulder dislocation\|dislocation]]

	==Differential Diagnosis==		==Differential Diagnosis==

ClaireLewis at 18:01, 28 September 2019

2019-09-28T18:01:44Z

← Revisión anterior		Revisión del 18:01 28 sep 2019
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	*Also known as "frozen shoulder syndrome"		*Also known as "frozen shoulder syndrome"
	*Inflammation of glenohumeral joint → joint capsule fibrosis, shoulder restriction		*Inflammation of glenohumeral joint → joint capsule fibrosis, shoulder restriction
	*Must rule-out posterior shoulder dislocation		*Must rule-out [[posterior shoulder dislocation]]
	*Associated with:		*Associated with:
	**[[Impingement Syndrome]]		**[[Impingement Syndrome]]
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	==Evaluation==		==Evaluation==
	*Clinical diagnosis, consider X-ray to rule out fracture/dislocation		*Clinical diagnosis, consider X-ray to rule out [[fracture]]/[[joint dislocation\|dislocation]]

	==Differential Diagnosis==		==Differential Diagnosis==

ClaireLewis: /* Management */

2019-09-24T04:03:01Z

Management

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	*Avoid immobilization		*Avoid immobilization
	*PT		*PT
	*Analgesia		*[[Analgesia]]
	**[[NSAIDs]], [[opioids]]		**[[NSAIDs]], [[opioids]]
	*Oral [[steroids]]		*Oral [[steroids]]

ClaireLewis at 18:17, 17 August 2019

2019-08-17T18:17:50Z

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	**Postmenopause		**Postmenopause
	**[[Diabetes Mellitus\|DM]]		**[[Diabetes Mellitus\|DM]]
	**Thyroid disease		**[[Thyroid disease]]
	**Pulmonary neoplasm		**Pulmonary neoplasm
	**Autoimmune		**Autoimmune

	==Clinical Features==		==Clinical Features==
			*Hallmark is limited active and passive range of motion
			*Shoulder pain
			**Diffuse, aching, poorly localized, accompanied by stiffness, worse at night
			**Not typically reproducible by palpation

	*Stage 1 (first 2-3mo)		*Stage 1 (first 2-3mo)
	**Acute synovial inflammation with limitation of shoulder movement due to pain		**Acute synovial inflammation with limitation of shoulder movement due to pain
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	==Evaluation==		==Evaluation==
	*~~Hallmark is limited active and passive range of motion~~		*Clinical diagnosis, consider X-ray to rule out fracture/dislocation
	*Pain
	**Diffuse, ~~aching, poorly localized, accompanied by stiffness, worse at night~~
	**Not typically reproducible by palpation

	==Differential Diagnosis==		==Differential Diagnosis==
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	*Analgesia		*Analgesia
	**[[NSAIDs]], [[opioids]]		**[[NSAIDs]], [[opioids]]
	*Oral steroids		*Oral [[steroids]]
	**Provide significant short-term benefit in terms of relieving pain and improving ROM		**Provide significant short-term benefit in terms of relieving pain and improving ROM
	*Intra-articular steroids (20-40mg triamcinolone)		*Intra-articular steroids (20-40mg triamcinolone)
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	==Disposition==		==Disposition==
	*~~Refer~~ to primary care for physical therapy		*Discharge, refer to primary care/ortho for physical therapy

	==References==		==References==

Kearny89: /* Management */

2019-06-15T00:53:22Z

Management

← Revisión anterior		Revisión del 00:53 15 jun 2019
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	==Management==		==Management==
	*Avoid immobilization		*Avoid immobilization
			*PT
	*Analgesia		*Analgesia
	**[[NSAIDs]], [[opioids]]		**[[NSAIDs]], [[opioids]]
	*Oral steroids		*Oral steroids
	**Provide significant short-term benefit in terms of relieving pain and improving ROM		**Provide significant short-term benefit in terms of relieving pain and improving ROM
			*Intra-articular steroids (20-40mg triamcinolone)
			**Benefits last a few months, possibly up to 6 months<ref>Sun Y, Zhang P, Liu S, et al. Intra-articular Steroid Injection for Frozen Shoulder: A Systematic Review and Meta-analysis of Randomized Controlled Trials With Trial Sequential Analysis. Am J Sports Med. 2017;45(9):2171-2179.</ref>
			*Joint distention
			**Intra-articular distention with 25-40mL of saline + anesthetic is as effective as IA steroids<ref>Lin MT, Hsiao MY, Tu YK, Wang TG. Comparative Efficacy of Intra-Articular Steroid Injection and Distension in Patients With Frozen Shoulder: A Systematic Review and Network Meta-Analysis. Arch Phys Med Rehabil. 2018;99(7):1383-1394.e6.</ref>

	==Disposition==		==Disposition==