CAUSES :
. Idiopathic (primary)
. Diseases and conditions associated with secondary adhesive capsulitis
. Trauma
. Diabetes
. Post-inflammatory
. Post CVA, post-MI, post-mastectomy (immobilization is the speculated cause)
. Hypo/hyper-thyroidism
. Avascular necrosis
. Tuberculosis
. Scleroderma
. Rheumatoid arthritis
. Lung cancer or chronic lung disease
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DIFFERENTIAL DIAGNOSIS
β’ Rotator cuff strain/tear
β’ Bicipital/rotator/calcifi c tendinitis
β’ Septic arthritis
β’ Bursitis
β’ Glenohumeral or AC joint osteoarthritis
β’ Rheumatoid arthritis
β’ Bony neoplasm/metastases
β’ Dislocation
β’ Fracture (distal clavicle, proximal humerus)
* Rule out systemic/autoimmune disease: TSH, ESR, ANA, CBC, glucose
IMAGING :
. Plain x-ray (AP, axillary, supraspinatus outlet views) to rule out osteoarthritis, calcific tendinitis, AVN, osteomyelitis, fracture, dislocation, and tumor
. AP - check osteopenia, fractures, dislocations, superior migration of humeral head
. Axillary - check subluxation or articular head damage
. Supraspinatus outlet views - check supraspinatus outlet narrowing to rule out acromial impingement
. Arthrography - joint volume is reduced to 5-10 mL (normal 20-30 mL). Since this is invasive, arthrography is reserved for patients with uncertain diagnosis.
. Consider MRI to evaluate rotator cuff
DIAGNOSTIC PROCEDURES :
. Joint aspiration if septic joint is suspected (rarely necessary)
. Arthroscopy to visualize fibrous bands in the joint space (rarely necessary)
* ARTHROGRAPHY DONE BY INJECTING < 15 ML OF CONTRAST IS DIAGNOSTIC.