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Update your Knowledge with MKSAP 18 Q&A: Answer and Critique

Answer

B: Adhesive capsulitis

Educational Objective

Diagnose adhesive capsulitis.

Critique

This patient's clinical presentation is most consistent with adhesive capsulitis, also known as frozen shoulder. Adhesive capsulitis commonly presents as poorly localized, progressive pain described as a deep aching with an insidious onset. Pain is also frequently worse at night and in cold weather. In addition to pain, patients with adhesive capsulitis frequently develop decreased shoulder mobility as the disease progresses. Range of motion (both active and passive) is decreased in all planes of motion. Adhesive capsulitis may be idiopathic (primary adhesive capsulitis) or secondary to several conditions (secondary adhesive capsulitis). Secondary conditions include diabetes mellitus, hypothyroidism, prior surgery or trauma, prolonged immobilization, autoimmune disorders, and stroke.

Acromioclavicular joint degeneration is unlikely to be responsible for this patient's clinical presentation. Patients with acromioclavicular joint degeneration typically report pain localized to the acromioclavicular joint. Physical examination findings include tenderness to palpation of the joint, pain with shoulder abduction beyond 120 degrees, and pain with passive shoulder adduction (a positive cross-arm test).

Bicipital tendinitis typically results in pain localized to the anterior shoulder that may radiate toward the deltoid and into the arm. Pain classically worsens with overhead activity. On examination, tenderness may be elicited by palpating the bicipital groove. Pain also can be reproduced by placing the patient's ipsilateral arm at his or her side while flexing the elbow to 90 degrees and supinating against resistance (Yergason test).

Rotator cuff disease would not be expected to cause pain with both active and passive movement of the shoulder; therefore, it would not account for this patient's presentation.

Key Point

Adhesive capsulitis is characterized by loss of shoulder movement accompanied by pain; examination discloses significant loss of both active and passive range of motion.

Bibliogrpahy

Le HV, Lee SJ, Nazarian A, Rodriguez EK. Adhesive capsulitis of the shoulder: review of pathophysiology and current clinical treatments. Shoulder Elbow. 2017;9:75-84. [PMID: 28405218] doi:10.1177/1758573216676786

Back to the September 2019 issue of ACP International