Frozen Shoulder Quiz
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Questions and Answers

What is the primary symptom of frozen shoulder?

  • Loss of active and passive shoulder range of motion (correct)
  • Pain only when lifting heavy objects
  • Swelling of the shoulder joint
  • Increased range of motion in the shoulder

Which demographic is most likely to develop frozen shoulder?

  • Children with genetic predispositions
  • Young athletes in training
  • Women between ages 40 and 70 (correct)
  • Men under 40 years old

What is the most common joint motion affected by frozen shoulder?

  • Shoulder internal rotation
  • Shoulder extension
  • Shoulder abduction (correct)
  • Shoulder flexion

What is a common misconception about the etiology of frozen shoulder?

<p>It has a strong genetic predisposition (B)</p> Signup and view all the answers

What percentage of individuals may experience bilateral involvement of frozen shoulder?

<p>10% to 40% (D)</p> Signup and view all the answers

Which of the following is NOT a part of the pathophysiology of frozen shoulder?

<p>Increased joint fluid secretion (A)</p> Signup and view all the answers

What is the typical recovery time for frozen shoulder with appropriate therapy?

<p>3 to 4 months (A)</p> Signup and view all the answers

Which treatment is typically required for cases of frozen shoulder that are part of a sympathetic reflex dystrophy?

<p>Sympathetic blocks or manipulation under anesthesia (A)</p> Signup and view all the answers

What does the total end-range time (TERT) primarily measure?

<p>The total time a joint is held at or near end-range (B)</p> Signup and view all the answers

What is a key consideration for stretches in patients with high irritability?

<p>Low-intensity, short duration stretches (C)</p> Signup and view all the answers

Which phase of treatment emphasizes aggressive stretching techniques?

<p>Adhesive phase (B)</p> Signup and view all the answers

What is the primary goal of the Spencer technique?

<p>To reduce pain and improve shoulder range of motion (B)</p> Signup and view all the answers

Which type of stretching provides the highest tensile stress doses?

<p>Low load prolonged stretching (LLPS) (B)</p> Signup and view all the answers

Which exercise type should be avoided during high irritability phases?

<p>Strengthening exercises (D)</p> Signup and view all the answers

What is the primary benefit of skillfully applied passive movement in the early phases of rehabilitation?

<p>It significantly accelerates improvement in range of motion. (D)</p> Signup and view all the answers

What approach should be taken when reintroducing exercises for individuals with low irritability?

<p>Gradually introduce strengthening exercises (C)</p> Signup and view all the answers

What role do modalities such as ice or superficial heat play in the treatment process during the acute stage?

<p>They provide relief from pain and muscle guarding. (C)</p> Signup and view all the answers

Which technique involves a series of shoulder manual treatments that dates back to 1916?

<p>Spencer technique (C)</p> Signup and view all the answers

Why is it recommended to perform Grade I or II joint-play mobilization while the patient is lying prone with the arm hanging freely?

<p>It provides the most comfortable position for patients and aids in relieving muscle spasm. (B)</p> Signup and view all the answers

What has been shown to be more effective than superficial heating for treating frozen shoulder patients?

<p>Deep heating through diathermy combined with stretching. (A)</p> Signup and view all the answers

What is a key focus of the rehabilitation program once satisfactory range of motion has been achieved?

<p>Maintaining existing range of motion while gently attempting to increase it. (B)</p> Signup and view all the answers

Which method is indicated to improve shoulder joint range of motion in patients with frozen shoulder?

<p>A combination of extracorporeal shock wave therapy (ESWT) and electroacupuncture. (B)</p> Signup and view all the answers

How does muscle spasm during the acute stage affect joint movement?

<p>It prevents effective stretching due to the reflexive contractions. (A)</p> Signup and view all the answers

What is the intended effect of applying moist heat in conjunction with stretching?

<p>To improve muscle extensibility. (D)</p> Signup and view all the answers

What indicates a positive coracoid pain test in patients suspected of adhesive capsulitis?

<p>Pain score of 3 points or higher (C)</p> Signup and view all the answers

What is the primary goal of the home exercise program (HEP) for patients with adhesive capsulitis?

<p>To maintain gains in treatment and improve mobility (B)</p> Signup and view all the answers

Which type of mobilization has been shown to be slightly more effective for patients with adhesive capsulitis symptoms lasting more than 3 months?

<p>End-range mobilization (A)</p> Signup and view all the answers

Which treatment option is typically considered when symptoms are unresponsive after 3-6 months?

<p>Surgical capsular release (C)</p> Signup and view all the answers

What is identified as a significant contributor to limitations in shoulder elevation and external rotation in patients with adhesive capsulitis?

<p>Subscapularis muscle (C)</p> Signup and view all the answers

How is distension therapy primarily intended to assist patients with adhesive capsulitis?

<p>By distending the joint capsule (D)</p> Signup and view all the answers

What is the primary cause of shoulder strength impairment in individuals with adhesive capsulitis?

<p>Weakness of glenohumeral internal rotators and flexors (D)</p> Signup and view all the answers

Which technique is suggested for reducing trigger point irritation in the subscapularis and latissimus dorsi muscles?

<p>Myofascial release (B)</p> Signup and view all the answers

What aspect of patient education is emphasized prior to initiating treatment for adhesive capsulitis?

<p>The natural history and chronicity of the condition (B)</p> Signup and view all the answers

Which imaging modality is specifically used to rule out osseous structure pathologies?

<p>Radiography (D)</p> Signup and view all the answers

What is the role of instrument-assisted soft tissue mobilization (IASTM) in treating adhesive capsulitis?

<p>To promote normal collagen alignment and improve microcirculation (A)</p> Signup and view all the answers

What observation during physical examination indicates a pathognomonic sign of shoulder adhesive capsulitis?

<p>Pain on pressure over the coracoid process (D)</p> Signup and view all the answers

How can adhesive capsulitis be differentiated from rotator cuff pathologies based on range of motion?

<p>Adhesive capsulitis presents with specific capsular patterns of restriction (D)</p> Signup and view all the answers

In the context of adhesive capsulitis, which duration and intensity of stretching is suggested to aid the plastic response?

<p>Low intensity, prolonged duration (B)</p> Signup and view all the answers

Why might some patients be falsely diagnosed with Frozen Shoulder?

<p>Significant increase in range of motion under anesthesia (D)</p> Signup and view all the answers

What characterizes the pain and limitation of movement in a posteriorly dislocated shoulder?

<p>Related to a specific traumatic event (D)</p> Signup and view all the answers

Scapular dysfunction in frozen shoulder syndrome is characterized by which of the following types of scapular movements?

<p>Upward rotation and external rotation (C)</p> Signup and view all the answers

How should patients quantify their pain during the coracoid pain test?

<p>On a visual analogue scale (VAS) of 0 to 10 (D)</p> Signup and view all the answers

What is a distinguishing feature of osteoarthritis compared to adhesive capsulitis in terms of passive range of motion?

<p>PROM is typically not limited in osteoarthritis (D)</p> Signup and view all the answers

What therapeutic approach is thought to elongate collagen fibers in the treatment of adhesive capsulitis?

<p>Continuous passive motion (D)</p> Signup and view all the answers

Which imaging study is most beneficial for identifying soft tissue abnormalities associated with adhesive capsulitis?

<p>Magnetic resonance imaging (MRI) (C)</p> Signup and view all the answers

What is primarily restricted in adhesive capsulitis affecting shoulder mobility?

<p>Inferior glenohumeral capsule and pectoral fascia (B)</p> Signup and view all the answers

What common symptom may suggest the presence of muscle guarding in a patient?

<p>Involuntary and painful muscle contraction (C)</p> Signup and view all the answers

Which statement accurately summarizes a feature of ultrasonography in the context of shoulder conditions?

<p>It can differentiate between soft tissue abnormalities and frozen shoulder (D)</p> Signup and view all the answers

Flashcards

Frozen shoulder

A condition where the shoulder joint becomes stiff and painful, limiting movement in multiple directions.

Pathophysiology of Frozen shoulder

The thickened, tight shoulder capsule forms scar tissue, called adhesions, which restricts movement.

Stages of Frozen shoulder

The stages of frozen shoulder are categorized by the severity of pain and limitation of movement.

Risk factors for Frozen shoulder

The condition is more common in women and individuals with thyroid disease or diabetes.

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Treatment of Frozen shoulder

Although frozen shoulder can resolve on its own, active treatment is crucial for quicker and better outcomes.

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Self-limiting condition

Frozen shoulder is a self-limiting condition that can improve with time.

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Recurrence of Frozen shoulder

Recurring frozen shoulder in the same shoulder is rare, but it can affect the opposite shoulder in some cases.

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Refractory Frozen shoulder

A frozen shoulder that doesn't respond well to traditional treatment and may require more specialized interventions.

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Frozen Shoulder (Adhesive Capsulitis)

A condition where the shoulder joint capsule becomes stiff and inflamed, leading to pain and limited range of motion.

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Capsular Pattern

The classic pattern of restricted shoulder movement in frozen shoulder, typically involving a specific sequence of limitations.

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Radiography

An X-ray examination used to visualize the bones of the shoulder, helping to rule out any bone abnormalities.

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Arthrography

A special type of X-ray that uses a contrast dye to better visualize the shoulder joint, helping identify potential problems with the joint capsule.

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Magnetic Resonance Imaging (MRI)

A non-invasive imaging technique that uses magnetic fields and radio waves to create detailed pictures of soft tissues like muscles, tendons, and ligaments, offering valuable information about the shoulder joint.

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Ultrasonography

An imaging technique that uses sound waves to create images of tendons and other soft tissues in the shoulder, helpful in distinguishing tendon issues from frozen shoulder.

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Osteoarthritis (OA)

A common condition characterized by wear and tear of the cartilage in the joints, often affecting the shoulder. It can present with similar symptoms to frozen shoulder.

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Rotator Cuff (RC) Pathologies

A condition affecting the tendons of the rotator cuff muscles, which help stabilize the shoulder joint. It can mimic the early stages of frozen shoulder.

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Adhesive Capsulitis

A condition where the shoulder joint capsule becomes inflamed and stiff, restricting movement. Often described as a 'frozen shoulder'.

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Coracoid Pain Test

A test used to diagnose adhesive capsulitis by applying pressure to the coracoid process, a bony projection near the shoulder joint. A positive test indicates pain in the coracoid area, a strong sign of adhesive capsulitis.

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Distension Therapy

A method of treating adhesive capsulitis using a combination of saline or local anesthetic and sometimes a steroid, injected into the shoulder joint. The goal is to stretch and loosen the stiff capsule.

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Manipulation Under Anesthesia (MUA)

A treatment for adhesive capsulitis that involves applying gentle manual pressure to the shoulder joint to break up adhesions and improve range of motion. This is often performed under anesthesia.

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Surgical Capsular Release

A treatment for adhesive capsulitis involving surgically cutting the shoulder joint capsule to release the tightness and improve range of motion.

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Home Exercise Program (HEP)

A home exercise program designed to maintain or improve range of motion in the shoulder. Regular exercise is crucial for recovering from adhesive capsulitis.

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Natural History of Adhesive Capsulitis

The gradual process of adhesive capsulitis developing and getting worse over time. It is characterized by stiffness, pain, and loss of movement in the shoulder.

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Visual Analogue Scale (VAS)

A scale used to assess the severity of pain, ranging from 0 (no pain) to 10 (most severe pain).

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Acute stage of frozen shoulder

Refers to the initial stage of a frozen shoulder, characterized by intense pain and limited range of motion.

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Joint-play mobilization

Gentle, controlled movements applied by a therapist to a joint to improve range of motion and reduce stiffness. It typically involves small, oscillating movements.

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Grade I or II joint-play oscillations

Grade I and II joint-play oscillations are gentle, small amplitude movements used in the acute stage of frozen shoulder to improve range of motion and reduce muscle guarding. They are particularly beneficial during the early stages when pain and inflammation are high.

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Modalities for frozen shoulder

Application of heat or cold to the affected area to reduce pain, inflammation, and muscle spasms. It often complements joint-play mobilization techniques.

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Iontophoresis

A type of therapy that combines physical stimulation with medication delivery through the skin using a mild electrical current. It is used to reduce inflammation and pain.

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Phonophoresis

Specialized ultrasound therapy where specific medications are applied to the skin, allowing ultrasound waves to drive them deeper into the tissue. This helps reduce pain and inflammation.

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Transcutaneous Electrical Nerve Stimulation (TENS)

A technique that applies electrical stimulation to the skin to block pain signals and promote relaxation. It is often used alongside other therapies to manage pain.

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Low-power laser therapy

Utilizing a laser to deliver low-intensity light energy to targeted tissues, which can reduce inflammation, pain, and promote tissue healing. It is another modality used to manage frozen shoulder symptoms.

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End-range mobilization

A type of mobilization technique that involves stretching the shoulder joint to its end range of motion.

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Mid-range mobilization

A type of mobilization technique that involves stretching the shoulder joint to a moderate range of motion.

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End-range mobilization effectiveness

Improves mobility and function in adhesive capsulitis patients, especially those with symptoms lasting over 3 months.

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Scapular mobilization

A type of mobilization technique that focuses on restoring proper movement patterns of the shoulder blade (scapula).

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Myofascial trigger points in frozen shoulder

Trigger points are sensitive areas within muscles, often contributing to pain and stiffness in frozen shoulder.

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Spray and Stretch for subscapularis

A technique that involves applying pressure to trigger points in the subscapularis muscle to reduce pain and tightness.

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Instrument-assisted soft tissue mobilization (IASTM)

A type of treatment that involves using tools to mobilize soft tissues and increase blood flow, potentially aiding in healing.

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Continuous passive motion (CPM) for adhesive capsulitis

A type of treatment that involves applying continuous gentle movement to the shoulder joint, aiming to lengthen collagen fibers.

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Total end range time (TERT)

The total amount of time a joint is held at or near its end range of motion.

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TERT Calculation

A measurement of the dose of tissue stress a joint receives during stretching exercises.

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Low Load Prolonged Stretching (LLPS)

A type of stretching where the joint is held at or near its end range for a prolonged period, at a low intensity.

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Spencer Technique

A manipulative technique used to treat frozen shoulder, consisting of a series of specific shoulder movements.

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High Irritability Stage

The stage of frozen shoulder where pain is high and movement is limited.

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Low Irritability Stage

The stage of frozen shoulder where pain and movement limitations have decreased.

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Strengthening Exercises

Exercises that aim to strengthen the muscles around the shoulder joint.

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Scapular Stabilization Exercises

Exercises that improve the stability of the shoulder blade.

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Study Notes

Frozen Shoulder

  • A painful, progressive, disabling condition affecting glenohumeral joint motion in multiple planes.
  • Adults aged 40-70, with higher prevalence in women and individuals with thyroid disease or diabetes.
  • No known genetic predisposition.
  • Non-dominant arm is slightly more affected than dominant arm.
  • Recurrence on the contralateral side is 6%-17% within 5 years; recurrence in the same shoulder is rare.
  • Bilateral involvement occurs in 10% to 40% of cases.

Objectives

  • Define frozen shoulder.
  • Explain etiology, pathophysiology, and classification of frozen shoulder.
  • Understand the different stages of frozen shoulder, including clinical manifestations.
  • Differentiate between frozen shoulder and other related pathological cases.
  • Know how to apply successful patient management.

Pathophysiology

  • Shoulder joint capsule thickens and tightens.
  • Scar tissue (adhesions) forms within the capsule.
  • Shoulder joint movement is reduced, leading to a 'frozen' state.
  • Shoulder ligaments become inflamed, limiting joint movement.
  • Joint pain is a result.

Classification of Frozen Shoulder

  • Primary: Occurs independently of other pathologies.
  • Secondary: Associated with another condition (e.g., trauma, surgery, systemic conditions like diabetes or thyroid problems, or intrinsic pathology like rotator cuff tear or bicep tendonitis).

Classification by Irritability

  • High irritability: High pain (7-10/10), consistent night or resting pain, high disability.
  • Moderate irritability: Moderate pain (4-6/10), intermittent pain.
  • Low irritability: Low pain (3/10), no resting or night pain, minimal disability.

Phases of Adhesive Capsulitis

  • Acute/Freezing Phase: Gradual shoulder pain at rest, sharp pain at extremes of motion, nighttime pain, and sleep interruption.
  • Adhesive/Frozen Phase: Pain subsides, progressive loss of glenohumeral motion in a capsular pattern. Pain is only evident at extreme movements.
  • Resolution/Thawing Phase: Spontaneous, progressive improvement in functional range of motion.

Clinical Presentation

  • Pain Site: Lateral brachial region, possibly referred to C5 or C6 segment, aggravated by movement.
  • Daily Activities: Difficulty with activities like reaching behind the back, overhead, or across the body.
  • Apley's Scratch Test: Assessment of shoulder range of motion.
  • Symptoms often start insidiously.

Limitations in Range of Motion

  • Limitations of active and passive glenohumeral joint ROM are common in multiple planes.
  • Losses greater than 50% have been reported.
  • Hallmark loss of motion follows a capsular pattern of restriction.
  • Initial loss of lateral rotation, followed by abduction, and lastly limitation in medial rotation

Differential Diagnosis

  • Osteoarthritis (OA): Can affect motion- but less than in frozen shoulder.
  • Rotator Cuff (RC) Pathologies: Distinguished by examination of ROM, as the loss of motion pattern is different than adhesive capsulitis.

Posterior Dislocation

  • Can present with shoulder pain and limited ROM but related to a specific traumatic event.

Additional Differentiation

  • Coracoid Pain Test: Pathognomonic sign of adhesive capsulitis involving pain on pressure over the coracoid process.
  • True vs. Pseudo Adhesive Capsulitis: True adhesive capsulitis involves more localized pain than Pseudo.

Treatment

  • Oral Medications: Corticosteroids.
  • Distension Therapy: Hydrodilation using fluid injections into the shoulder joint.
  • Physical Therapy:
  • Patient education, home exercise program.
  • Focused on increasing ROM in different stages using modalities and joint mobilization techniques.
  • Range of Motion exercises (low intensity and short duration, high intensity and short duration) to promote healing.
  • Operative Treatments: Manipulation under anesthesia or surgical capsular release (for unresponsive cases).

Additional Treatment Techniques

  • Specific Joint Mobilizations (Anteroinferior Capsular Stretch): Targeted stretching of specific areas of the shoulder capsule to restore movement.
  • High-Grade Mobilization Techniques (HGMT): Mobilization techniques for improving movement.
  • Positional Stretching (Coracohumeral Ligament): Targeted stretches meant for providing low-load and long stretches on the CHL and surrounding tissues.
  • Soft Tissue Mobilization (Graston Technique etc.): Techniques focusing on improving collagen remodeling and microcirculation.
  • Posture and Pain Management: Education and exercises to fix poor posture. In more acute cases, proper positioning is crucial to promote sleep quality.

Strengthening Exercises

  • Strengthening and aggressive functional activity is avoided when irritability is high or moderate. Gradually introduces resistance exercises as movement is regained to improve motion, stability, and strength.

Closed Kinetic Chain and Proprioceptive Exercises

  • Exercises for maintaining improvements, improving awareness, and promoting muscle co-contraction and improving capsular mobility.

Diagnosis

  • Often made by physical examination alone, supplemented by imaging studies to rule out pathology and confirm the diagnosis.
  • Radiography to rule out problems with bone.
  • Arthography to determine joint volume changes.
  • MRI and ultrasonography used to identify soft tissue abnormalities (rotator cuff/labrum/capsule/RCI).

Spencer Techniques

  • Osteopathic manipulative technique with a series of manual treatments for pain reduction and improved shoulder ROM.

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Description

This quiz explores the features of frozen shoulder, including definitions, etiology, pathophysiology, and clinical manifestations. Test your knowledge on the stages of frozen shoulder, its differentiation from related conditions, and effective patient management strategies.

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