Most Effective Frozen Shoulder Treatment
The most common shoulder problems are impingement syndrome with rotator cuff tears, calcific tendinitis, adhesive capsulitis, acromioclavicular joint pain, thoracic outlet syndrome, and shoulder instability. C. Adhesive capsulitis (frozen shoulder), frequently seen during the fifth and sixth decades, may develop as a result of intrinsic shoulder pathology or occur secondary to extrinsic causes, particularly cervical spondylosis. Often, no specific etiologic factor can be found. 7. Metastatic lesions involving the shoulder, spine, or brachial plexus may present as an adhesive capsulitis. 4. The shoulder-hand syndrome (reflex sympathetic dystrophy), a poorly understood and uncommon basis for shoulder pain, is associated with diffuse swelling, pain, and vasomotor changes in the distal upper extremity (see Chapter53). The problem occurs in elderly subjects and is sometimes related to myocardial infarction or other cardiopulmonary conditions. Unless an exercise...
Adhesive capsulitis is an idiopathic inflammatory synovitis in the glenohumeral joint. It occurs three to seven times more frequently in women than in men. The cause is not well understood, but the clinical entity is frequently associated with other conditions, such as diabetes and menopause. Four distinct stages have been recognized, which reflect the degree of synovitis. The cornerstones of treatment include intraarticular steroid injection and a rehabilitation program to maintain strength and range of motion. Manipulation under anesthesia and arthroscopy may be required.
Shortly following surgery and usually in the perioperative period two different types of problems arise. The first is adhesive capsulitis, in which there is a general inflammatory response with loss of motion and pain. The patient, if sent for arthrography, generally is uncomfortable and demonstrates pain as the needle approaches the shoulder capsule. The volume of contrast that is administered is reduced, usually to a total of less than 8 mL. The MRI Fig. 5. Adhesive capsulitis. T1 fat suppressed axial image demonstrates a paucity of contrast surrounding the humeral head consistent with lack of distention secondary to small injected volume. There is also contrast seen extending into the subcoracoid region of the subscapularis bursa.
More than one basis for pain may be present for example, in patients with cervical spondylosis and referred pain to the shoulder, limitation of shoulder motion secondary to adhesive capsulitis may also develop (see section C 2). Also, pain can be referred from diseases involving the heart, lung, or gall bladder. 2. From ages 40 to 50 years, the impingement syndrome, calcific tendinitis, and adhesive capsulitis become more common. 3. From ages 50 to 70 years, the impingement syndrome may progress to a full-thickness rotator cuff tear. In addition, adhesive capsulitis is common. Degenerative lesions of the acromioclavicular, sternoclavicular, and occasionally the glenohumeral joints become more frequent. Pain from metastatic disease should be considered.
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