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"> | |||
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== | == Search Strategy == | ||
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== Definition/Description == | |||
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== Epidemiology /Etiology == | |||
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== Characteristics/Clinical Presentation == | |||
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== Differential Diagnosis == | |||
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== Examination == | |||
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== Medical Management (current best evidence) == | |||
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== Physical Therapy Management (current best evidence) == | |||
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== | == Key Research == | ||
Adhesive capsulitis has been reported to affect 2-3% of the general population and up to 30% of people with type II diabetes. It is more common in women aged 40-60. <ref name="Walmsley" /> While recurrence in the same shoulder is rare, contra-lateral shoulder involvement has been estimated between 20-30%.<ref name="Brue" /> Other identified risk factors include cervical disk disease, iimmobilization of the shoulder, cardiovascular disease, pulmonary disease, hyperthyroidism, and autoimmune diseases. <ref name="Jewell">Jewell DV et al. | 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> | ||
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== References == | |||
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[[Category:Texas_State_University_EBP_Project|Template:TXSTEBP]]''' | |||
'''Original Editor '''- [[User:Dawn Waugh|Dawn Waugh]] | |||
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== Clinically Relevant Anatomy<br> == | |||
Adhesive capsulitis is also known as frozen shoulder. 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> Adhesive capsulitis can be primary when it is idiopathic or secondary when it results from a known cause or surgical event. <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> | |||
== Mechanism of Injury / Pathological Process<br> == | |||
Adhesive capsulitis has been reported to affect 2-3% of the general population and up to 30% of people with type II diabetes. It is more common in women aged 40-60. <ref name="Walmsley" /> While recurrence in the same shoulder is rare, contra-lateral shoulder involvement has been estimated between 20-30%.<ref name="Brue" /> Other identified risk factors include cervical disk disease, iimmobilization of the shoulder, cardiovascular disease, pulmonary disease, hyperthyroidism, and autoimmune diseases. <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> | |||
== Clinical Presentation == | == Clinical Presentation == | ||
Patients may report progressive difficulty with dressing, grooming, and performing overhead activities. Literature describes adhesive capsulitis occuring in three overlapping phases. The first phase, the painful stage, involves painful shoulder motion and sleep being interrupted. The second state, the frozen or adhesive stage, is characterized by reduced pain and loss of joint motion. During the third stage, the resolution or thawing stage, pain is resolved and motion is gradually returned. <ref name="Jewell" /><ref name="Walmsley" /> 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> | Patients may report progressive difficulty with dressing, grooming, and performing overhead activities. Literature describes adhesive capsulitis occuring in three overlapping phases. The first phase, the painful stage, involves painful shoulder motion and sleep being interrupted. The second state, the frozen or adhesive stage, is characterized by reduced pain and loss of joint motion. During the third stage, the resolution or thawing stage, pain is resolved and motion is gradually returned. <ref name="Jewell" /><ref name="Walmsley" /> 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> | ||
== Diagnostic Procedures == | == Diagnostic Procedures == | ||
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*generally age of onset is >35 years old. <ref name="Walmsley" /> | *generally age of onset is >35 years old. <ref name="Walmsley" /> | ||
<br> | <br> | ||
In addition, if radiographs are taken, they are typically normal. <ref name="Brue" /> | In addition, if radiographs are taken, they are typically normal. <ref name="Brue" /> | ||
== Outcome Measures == | == Outcome Measures == | ||
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DASH (see [[Outcome Measures|Outcome Measures Database]]) | DASH (see [[Outcome Measures|Outcome Measures Database]]) | ||
== Management / Interventions<br> | == Management / Interventions<br> == | ||
Research has shown that joint mobilization and exercise increases the likelihood of successful outcomes. Passive range of motion improved with Matiland grade III or IV mobilizations and posteriorly directed Kaltenborn grade III mobilizations. Two pairs of interventions: iontophoresis and phonophoresis and ultrasound and massage, decreased the likelihood of significant improvement by 19-32%. <ref name="Jewell" /><br> | Research has shown that joint mobilization and exercise increases the likelihood of successful outcomes. Passive range of motion improved with Matiland grade III or IV mobilizations and posteriorly directed Kaltenborn grade III mobilizations. Two pairs of interventions: iontophoresis and phonophoresis and ultrasound and massage, decreased the likelihood of significant improvement by 19-32%. <ref name="Jewell" /><br> | ||
Intraarticular corticosteroid injections are another treatment option. Random, controlled studies show injections with an exercise program improved pain and function scores at 2 weeks, but no difference at 12 weeks. Therefore, cotricosteroids help initially with pain and function during the first few weeks, but not in the long term. <ref name="Bal">Bal A et al. | Intraarticular corticosteroid injections are another treatment option. Random, controlled studies show injections with an exercise program improved pain and function scores at 2 weeks, but no difference at 12 weeks. Therefore, cotricosteroids help initially with pain and function during the first few weeks, but not in the long term. <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. Following arthroscopic release, patients demonstrated improved range of motion, functional scores, and decreased pain. <ref name="Baums">Baums MH et al. | Baums et al analyzed 30 patient who had not improved with 6 months of conservative treatment. Following arthroscopic release, patients demonstrated improved range of motion, functional scores, and decreased pain. <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> | ||
== Differential Diagnosis<br> | == Differential Diagnosis<br> == | ||
Differenctial diagnoses include rotator cuff tear, rotator cuff impingment, OA. <br> | Differenctial diagnoses include rotator cuff tear, rotator cuff impingment, OA. <br> | ||
== Key Evidence == | == Key Evidence == | ||
add text here relating to key evidence with regards to any of the above headings<br> | add text here relating to key evidence with regards to any of the above headings<br> | ||
== Resources <br> | == Resources <br> == | ||
add appropriate resources here | add appropriate resources here | ||
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== Case Studies == | == Case Studies == | ||
add links to case studies here (case studies should be added on new pages using the [[Template:Case Study|case study template]])<br> | add links to case studies here (case studies should be added on new pages using the [[Template:Case Study|case study template]])<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]) == | ||
<div class="researchbox"> | <div class="researchbox"> | ||
<rss>http://eutils.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=1zWVHjJausiwg5hEuVdQe3RvJQhM4UhVDIGVzy-wKznwT1OMVr|charset=UTF-8|short|max=10</rss> | <rss>http://eutils.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=1zWVHjJausiwg5hEuVdQe3RvJQhM4UhVDIGVzy-wKznwT1OMVr|charset=UTF-8|short|max=10</rss> | ||
</div> | </div> | ||
== References == | == References == | ||
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<references /> | <references /> | ||
[[Category:Articles]] [[Category:Assessment]] [[Category:Condition]] [[Category:EBP]] [[Category:Elbow]] [[Category:EIM_Student_Project_2]] [[Category:Musculoskeletal/Orthopaedics]] [[Category:Shoulder]] | |||
Revision as of 01:38, 6 November 2010
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]
see adding references tutorial.
Original Editor - Dawn Waugh
Lead Editors - Your name will be added here if you are a lead editor on this page. Read more.
Clinically Relevant Anatomy
[edit | edit source]
Adhesive capsulitis is also known as frozen shoulder. It involves progressive stiffness of the glenohumeral joint.[1] Adhesive capsulitis can be primary when it is idiopathic or secondary when it results from a known cause or surgical event. [2]
Mechanism of Injury / Pathological Process
[edit | edit source]
Adhesive capsulitis has been reported to affect 2-3% of the general population and up to 30% of people with type II diabetes. It is more common in women aged 40-60. [2] While recurrence in the same shoulder is rare, contra-lateral shoulder involvement has been estimated between 20-30%.[1] Other identified risk factors include cervical disk disease, iimmobilization of the shoulder, cardiovascular disease, pulmonary disease, hyperthyroidism, and autoimmune diseases. [3]
Clinical Presentation[edit | edit source]
Patients may report progressive difficulty with dressing, grooming, and performing overhead activities. Literature describes adhesive capsulitis occuring in three overlapping phases. The first phase, the painful stage, involves painful shoulder motion and sleep being interrupted. The second state, the frozen or adhesive stage, is characterized by reduced pain and loss of joint motion. During the third stage, the resolution or thawing stage, pain is resolved and motion is gradually returned. [3][2] 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. [1]
Diagnostic Procedures[edit | edit source]
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.
- 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 >35 years old. [2]
In addition, if radiographs are taken, they are typically normal. [1]
Outcome Measures[edit | edit source]
DASH (see Outcome Measures Database)
Management / Interventions
[edit | edit source]
Research has shown that joint mobilization and exercise increases the likelihood of successful outcomes. Passive range of motion improved with Matiland grade III or IV mobilizations and posteriorly directed Kaltenborn grade III mobilizations. Two pairs of interventions: iontophoresis and phonophoresis and ultrasound and massage, decreased the likelihood of significant improvement by 19-32%. [3]
Intraarticular corticosteroid injections are another treatment option. Random, controlled studies show injections with an exercise program improved pain and function scores at 2 weeks, but no difference at 12 weeks. Therefore, cotricosteroids help initially with pain and function during the first few weeks, but not in the long term. [4]
Baums et al analyzed 30 patient who had not improved with 6 months of conservative treatment. Following arthroscopic release, patients demonstrated improved range of motion, functional scores, and decreased pain. [5]
Differential Diagnosis
[edit | edit source]
Differenctial diagnoses include rotator cuff tear, rotator cuff impingment, OA.
Key Evidence[edit | edit source]
add text here relating to key evidence with regards to any of the above headings
Resources
[edit | edit source]
add appropriate resources here
Case Studies[edit | edit source]
add links to case studies here (case studies should be added on new pages using the case study template)
Recent Related Research (from Pubmed)[edit | edit source]
Failed to load RSS feed from http://eutils.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=1zWVHjJausiwg5hEuVdQe3RvJQhM4UhVDIGVzy-wKznwT1OMVr|charset=UTF-8|short|max=10: Error parsing XML for RSS
References[edit | edit source]
References will automatically be added here, see adding references tutorial.
- ↑ 1.0 1.1 1.2 1.3 Brue S et al. Idiopathic adhesive capsulitis of the shoulder: a review. Knee Surg Sports Traumatol Arthrosc. 2007. 15:1048-1054.
- ↑ 2.0 2.1 2.2 2.3 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.
- ↑ 3.0 3.1 3.2 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.
- ↑ Bal A et al. Effectiveness of Corticosteroid Injection in Adhesive Capsulitis. Clinical Rehabiliation. 2008; 22:503-512.
- ↑ 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.
