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Frozen Shoulder Stiff shoulder, described alternatively as adhesive capsulitis, characterizes itself through insidious onset and decreased ROM (both active and passive). The exact etiology is unkown, though it may be an underlying inflammatory process. |
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Symptoms Classic signs consist of pain and motion loss without known trauma or injury. At risk are middle aged women and patients with clinical depression. Insulent dependent diabetes mellitus may bear a stubborn type of frozen shoulder. Other associated conditions are: myocardial function, hypothyroidism, recent surgical procedure, and Parkinson's disease.
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| Test
Look for significant reductions in both active and passive ROM by half compared with the other shoulder. On the other hand, rotator cuff tear exhibits passive motion as normal, while active ROM is poor. Motion is painful at the extremes, palpation shows tenderness around the cuff. Patients also report "stiff fingers." They might not be able to join their fingers and palms together in the "praying position."
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| Diagnostic Procedure
Regular shoulder radiographs are indicated to rule out underlying tumor or calcium deposit; graphs are usually normal. Arthography or an MRI scan is indicated in patients with no improvement after 3 months.
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| Treatment
NSAIDs and non-narcotic analgesics, along with physical therapy. Use the Jackins exercise proram (University of Washington [Jackins] exercises for stiff shoulers) and instruct the patient to undergo exercise four times a day with hopes of patient doing it twice a day. Supervision from a physical therapist once a week for six weeks is ideal, but success depends on the home exercises and the patient's commitment to them. After 12 weeks, shoulder manipulation under anesthesia may be indicated—with the exception of an insulin dependent diabetes mellitus patient requiring more aggressive arthroscopic capsular releases.
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| >>> on to Glenohumeral Instability
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