-IBIS-1.5.0-
tx
musculoskeletal system
frozen shoulder
diagnoses

definition and etiology

definition:
A syndrome in which a stiff shoulder is restricted and painful in both active and passive movement; aka "adhesive capsulitis", "periarthritis" and "pericapsulitis".

etiology:
The involved joints are the scapulothoracic and glenohumeral. There is no bony ankylosis. Causes include any type of pain in the shoulder upon movement, and immobilization from shoulder injury. Frozen shoulder is seen most often in patients with tendency to tension, anxiety, and passive apathy (termed the "periarthritic personality"), combined with a low pain tolerance.

The pathology of frozen shoulder is believed to be as follows: pain in the shoulder (neurologic, vascular, musculoskeletal, or referred visceral): causes vasospasm which leads to congestion and myospasm which leads to disuse and further vascular congestion. This initiates the development of fibrous tissues that are responsible for functional disability.

signs and symptoms

• Painful limitation of the glenohumeral joint which gradually becomes less painful but more restricted in motion.
• Abduction is normal at first and then, as the condition progresses, is restricted because of pain.
• Advanced stages: no pain with immobilization, but pain in all ROM of the shoulder; patient carries the arm in adduction and internal rotation.

course and prognosis

The untreated course ends in total immobilization of the shoulder joint. Prevention is the best treatment. Once the condition is established, cure becomes increasingly difficult. It is unusual for a complete recovery to occur in frozen shoulder patients. Conventional treatment consists of drug therapy (muscle relaxants, sedatives, tranquilizers, analgesics); manipulation of the shoulder; passive and active ROM exercises; ice; physiotherapy; and psychological counseling to dispel any anxiety and dependency that may be primary or secondary to the frozen shoulder.

differential diagnosis

• bursitis
• dislocation
• rotator cuff tear
• tenosynovitis
• neurologic phenomena
• CVA sequelae


footnotes