Adhesive Capsulitis (Frozen Shoulder)A disorder in which the shoulder capsule becomes inflamed and stiff, greatly restricting motion and causing pain.
The etiology is unknown (injury or trauma, autoimmune).
Characterized by progressive pain and stiffness which usually resolves spontaneously after 18 months.
Movement of the shoulder is severely restricted, pain is worse at night.

Clinical Features
Age 40-60, more in females
Slight wasting, some tenderness.
Pain (gradual onset)
Stiffness or decrease in motion.
External rotation (most severely inhibited)
Internal rotation
Abduction.

Radiology
X-ray:
Osteoporosis of the proximal humerus (decreased bone density)
Arthrography:
Shows a contracted joint
Dramatic decrease in the injected contrast material.
Loss of normally loose dependent folds of the capsule.

Differential Diagnosis
Post-traumatic stiffness (maximal at the start, gradually lessens)
Disuse stiffness
Regional pain syndrome (associated with MI, stroke)

Treatment
self-limiting: it usually resolves over time without surgery. Movement is regained gradually but may not return to normal
Conservative:
Analgesics
Heat therapy and exercise(physiotherapy)
Corticosteroid injection.
Manipulation under anesthesia hastens recovery.

Operative Treatment
Arthroscopic division of the interval between supraspinatous and infraspinatous (improve the range of movement).

Shoulder Instability (Dislocation)
Occurs when the humerus separates from the scapula at the glenohumeral joint. The glenoid socket is very shallow and the joint is held secure by the fibrocartilaginous glenoid (labrum) and the surrounding ligaments and muscles.
Types
Anterior instability.
Posterior instability.
Multidirectional instability.

Treatment

Reduction:
Most techniques are facilitated by the following 2 maneuvers:
Flexion of the elbow 90° to relax the biceps tendon
External rotation of the humerus, which releases the superior glenohumeral ligament and presents the favorable side of the humeral head to the glenoid fossa
Signs of a successful reduction include the following:
Palpable or audible clunk
Return of rounded shoulder contour
Relief of pain
Increase in range of motion

Stimson Maneuver, Scapular Manipulation, External rotation method, Traction and counter traction

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