Frozen Shoulder: Difference between revisions

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<div class="noeditbox">Welcome to [[Texas State University Evidence-based Practice Project|Texas State University's Evidence-based Practice project space]]. This is a wiki created by and for the students in the Doctor of Physical Therapy program at Texas State University - San Marcos. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!</div><div class="editorbox">
<div class="noeditbox">Welcome to [[Vrije Universiteit Brussel Evidence-based Practice Project|Vrije Universiteit Brussel's Evidence-based Practice project]]. This is a wiki created by and for the students in the Rehabilitation Sciences and Physiotherapy program of the Vrije Universiteit Brussel, Brussels, Belgium. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!</div> <div class="editorbox">
'''Original Editors''' - [[User:Dawn Waugh|Dawn Waugh]]
'''Original Editors '''  


'''Lead Editors''' - [[User:Sarah Grafelman|Sarah Grafelman]],
'''Lead Editors''' - Your name will be added here if you are a lead editor on this page.&nbsp; [[Physiopedia:Editors|Read more.]]  
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== Search Strategy  ==
== Search Strategy  ==


add text here related to databases searched, keywords, and search timeline <br>
add text here related to databases searched, keywords, and search timeline <br>  


== Definition/Description  ==
== Definition/Description  ==


Adhesive capsulitis is also known as frozen shoulder.&nbsp; It involves progressive stiffness of the glenohumeral joint.<ref name="Brue">Brue S et al. Idiopathic adhesive capsulitis of the shoulder: a review. Knee Surg Sports Traumatol Arthrosc. 2007. 15:1048-1054.</ref>&nbsp;&nbsp; Adhesive capsulitis can be primary when it is idiopathic or secondary when it results from a known cause or surgical event.&nbsp; <ref name="Walmsley">Walmsley S et al. Adhesive Capsulitis: Establishing Consensus on Clinical Identifiers for Stage 1 Using the Delphi Technique. Physical Therapy. September, 2009. 89(9): 906-917.</ref><br>
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== Epidemiology /Etiology  ==
== Epidemiology /Etiology  ==


Adhesive capsulitis has been reported to affect 2-3% of the general population and up to 30% of people with type II diabetes.&nbsp; It is more common in women aged 40-60. <ref name="Walmsley" />&nbsp; While recurrence in the same shoulder is rare, contra-lateral shoulder involvement has been estimated between 20-30%.<ref name="Brue" />&nbsp; Other identified risk factors include&nbsp; cervical disk disease, iimmobilization of the shoulder, cardiovascular disease, pulmonary disease, hyperthyroidism, and autoimmune diseases.&nbsp; <ref name="Jewell">Jewell DV et al. Interventions Associated With an Increased or Decreased Likelihood of Pain Reduction and Improved Function in Patients With Adhesive Capsulitis: A Retrospective Cohort Study. Physical Therapy. May, 2009. 89(5): 419-428.</ref><br>
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== Characteristics/Clinical Presentation  ==
== Characteristics/Clinical Presentation  ==


Patients may report progressive difficulty with dressing, grooming, and performing overhead activities. Literature describes adhesive capsulitis occuring in three overlapping phases.&nbsp; The first phase, the painful stage, involves painful shoulder motion and sleep being interrupted.&nbsp; The second state, the frozen or adhesive stage,&nbsp; is characterized by reduced pain and loss of joint motion.&nbsp; During the third stage, the resolution or thawing stage, pain is resolved and motion is gradually returned.&nbsp; <ref name="Jewell" /><ref name="Walmsley" />&nbsp; Adhesive capsulitis is thought to be self-limiting with the average recovery taking 3 years, though some authors report 50% of patients have pain or stiffness at 7 years. <ref name="Brue" /><br>
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== Differential Diagnosis  ==
== Differential Diagnosis  ==
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== Examination  ==
== Examination  ==


Though there is no valid clinical diagnostic criteria for adhesive capsulitis, a recent study gathered the opinions of 70 experts in adhesive capsulitis. They came to the following conensus on characteristics of people with adhesive capsulitis.
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*night pain
*increase pain with rapid or unguarded movement
*pain is aggravated by movement
*increased discomfort lying on affected side
*global loss of active and passive motion
*pain at end range in all directions
*generally age of onset is &gt;35 years old.&nbsp;&nbsp;<ref name="Walmsley" />
 
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In addition, if radiographs are taken, they are typically normal.&nbsp; <ref name="Brue" />
 
DASH (see [[Outcome Measures|Outcome Measures Database]])
 
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== Medical Management (current best evidence)  ==
== Medical Management (current best evidence)  ==


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== Physical Therapy Management (current best evidence)  ==
== Physical Therapy Management (current best evidence)  ==


Research has shown that joint mobilization and exercise increases the likelihood of successful outcomes.&nbsp; Passive range of motion improved with Matiland grade III or IV mobilizations and posteriorly directed Kaltenborn grade III mobilizations.&nbsp; Two pairs of interventions:&nbsp; iontophoresis and phonophoresis and ultrasound and massage, decreased the likelihood of significant improvement by 19-32%.&nbsp; <ref name="Jewell" /><br>
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Intraarticular corticosteroid injections are another treatment option.&nbsp; Random, controlled studies show injections with an exercise program improved pain and function scores at 2 weeks, but no difference at 12 weeks.&nbsp; Therefore, cotricosteroids help initially with pain and function during the first few weeks, but not in the long term.&nbsp; <ref name="Bal">Bal A et al. Effectiveness of Corticosteroid Injection in Adhesive Capsulitis. Clinical Rehabiliation. 2008; 22:503-512.</ref>
 
Baums et al analyzed 30 patient who had not improved with 6 months of conservative treatment.&nbsp; Following arthroscopic release, patients demonstrated improved range of motion, functional scores, and decreased pain.&nbsp; <ref name="Baums">Baums MH et al. Functional Outcome and General Health Status in Patients after Arthroscopic Release in Adhesive Capsulitis. Knee Surg Sports Traumatol Arthrosc. 2007; 15:638-644.</ref>
 
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== Key Research  ==
== Key Research  ==


add links and reviews of high quality evidence here (case studies should be added on new pages using the [[Template:Case Study|case study template]])<br>
add links and reviews of high quality evidence here (case studies should be added on new pages using the [[Template:Case Study|case study template]])<br>  


== Resources <br> ==
== Resources <br> ==


add appropriate resources here <br>
add appropriate resources here <br>  


== Clinical Bottom Line  ==
== Clinical Bottom Line  ==


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add text here <br>  


== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed])  ==
== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed])  ==
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see tutorial on [[Adding PubMed Feed|Adding PubMed Feed]]  
see tutorial on [[Adding PubMed Feed|Adding PubMed Feed]]  
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<rss>http://eutils.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=1zWVHjJausiwg5hEuVdQe3RvJQhM4UhVDIGVzy-wKznwT1OMVr|charset=UTF-8|short|max=10</rss>
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== References  ==
== References  ==


see [[Adding References|adding references tutorial]].  
see [[Adding References|adding references tutorial]].  


<references />
<references />  


[[Category:Texas_State_University_EBP_Project|Template:TXSTEBP]] [[Category:Articles]] [[Category:Assessment]] [[Category:Condition]] [[Category:EBP]] [[Category:Elbow]] [[Category:EIM_Student_Project_2]] [[Category:Musculoskeletal/Orthopaedics]] [[Category:Shoulder]]
[[Category:Vrije Universiteit Brussel Project]]

Revision as of 21:53, 8 November 2010

Welcome to Vrije Universiteit Brussel's Evidence-based Practice project. This is a wiki created by and for the students in the Rehabilitation Sciences and Physiotherapy program of the Vrije Universiteit Brussel, Brussels, Belgium. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!

Original Editors

Lead Editors - Your name will be added here if you are a lead editor on this page.  Read more.

Search Strategy[edit | edit source]

add text here related to databases searched, keywords, and search timeline

Definition/Description[edit | edit source]

add text here

Epidemiology /Etiology[edit | edit source]

add text here

Characteristics/Clinical Presentation[edit | edit source]

add text here

Differential Diagnosis[edit | edit source]

add text here

Examination[edit | edit source]

add text here

Medical Management (current best evidence)[edit | edit source]

add text here

Physical Therapy Management (current best evidence)[edit | edit source]

add text here

Key Research[edit | edit source]

add links and reviews of high quality evidence here (case studies should be added on new pages using the case study template)

Resources
[edit | edit source]

add appropriate resources here

Clinical Bottom Line[edit | edit source]

add text here

Recent Related Research (from Pubmed)[edit | edit source]

see tutorial on Adding PubMed Feed

Extension:RSS -- Error: Not a valid URL: Feed goes here!!|charset=UTF-8|short|max=10

References[edit | edit source]

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