TERMINOLOGY
CLINICAL CLARIFICATION 6
• Frozen shoulder (adhesive capsulitis or ACS) is a temporary (usually a year or less in duration) orthopedic condition characterized by intense, mostly anterior, unilateral shoulder pain that accompanies a dramatic reduction in range of motion (ROM) of the joint in all directions.
CLASSIFICATION 2
• An informal classification of adhesive capsulitis breaks down the condition by its temporal stages: o Freezing stage
- First four months of the condition, persistent shoulder pain and very limited range of motion o Frozen stage
- Fourth through eighth month, limited range of motion continues but pain becomes intermittent and only with movement or attempted movement of the joint o Thawing stage
- Eighth through
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o There is a notable lack of symptoms referable to conventional order of patient interview (i.e., the patient is generally asymptomatic except with regard to the pain and limited range of motion of the involved shoulder) o The principle complaint is one of trouble moving the arm, one shoulder usually, with pain in thejoint from morning to night, even at rest
- E.g., "I cannot reach up on the highest shelf and get something" or "I cannot reach behind my back at all" AND "It hurts" o Pain is usually intense and brings the patient to medical care within a few days or weeks of onset o Pain is anterior or anterolateral and constant, without a specific incident of incite or recall of injury; however, the patient WILL remember when the pain started, usually very specifically and to the hour (e.g., "This all started last Wednesday, right after work, when Iwas at home." o If there is bilateral shoulder pain it is usually serial in nature: one shoulder hurts then quits, the opposite then becomes symptomatic o There is a notable lack of neurologic symptoms (i.e., lack of paresthesia, radiation, diminished sensation) in the shoulder area or arm o Most significantly, there may be a personal history of diabetes which is a frequent co-morbid accompaniment of adhesive
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o In presence of systemic arthropathy, consultation with a Rheumatic Diseases specialist is indicated (e.g., positive rheumatoid factor, anti-nuclear antibodies) o Referral to Pain Specialist (e.g., evaluation of refractory pain may be necessary in isolated cases)
TREATMENT OPTIONS 6• 7• 1o
• The clinical course of adhesive capsulitis of the shoulder is self-limiting and symptomatic improvement with conservative treatment usually occurs within 1year
• Nonsteroidal anti-inflammatory drugs (NSAIDs) o Those who are allergic or intolerant of NSAIDs may take acetaminophen
• Intra-articular corticosteroid injection 3
• Oral corticosteroids
• Physical therapy (i.e., shoulder exercises) to improve range of motion and maintain muscular strength
• Occupational therapy where specific motor skills must be retained or recovered
• Suprascapular nerve block where immediate return to work may be necessary 3
• Endoscopic surgery (i.e., arthroscopic release) may be an option in rare cases where spontaneous resolution does not occur in a timely manner
• Drug therapy 10 o Nonsteroidal anti-inflammatory drugs (NSAID)
- Indicated for analgesia o Ibuprofen o Naproxen o Diclofenac
- Acetaminophen o For analgesia where NSAIDs are contraindicated (e.g., Gl