PCL 4 - Differential Diagnosis (Arthritis & Frozen Shoulder)

Hey guys! (Isn't this a nice colour?? =D) Take note of the words in blue cos that's what I think are the main difference between the particular problem and the rotator cuff tendinopathy. Oh and the picture too!

Glenohumeral Arthritis (Shoulder Arthritis)

• progressive weakening of the smooth joint cartilage

• involved in inflammatory arthropathies such as Rheumatoid Arthritis (RA)
  uncommon site for Osteoarthritis (OA)

  → signs & symptoms of RA will differentiate glenohumeral arthritis with rotator cuff tendinopathy

• Symptoms include
  - Stiff shoulder (may appear like a frozen shoulder)
  - Painful shoulder – related to movement
  - Clicking, crunching or clonking sounds on movement
  - Loss of shoulder movement
  - (Not usually painful at night)
  - Clearly identified on x-ray

• commonly anterior shoulder pain BUT for rotator cuff tendinopathy – pain in lateral deltoid area (aggravated by reaching overhead)

• differentiation between glenohumeral joint disease and rotator cuff typically determined by history (see picture)

Adhesive Capsulitis (Frozen Shoulder)

• What are the stages of a frozen shoulder?

  - Painful/Freezing Stage

  This is the most painful stage of a frozen shoulder. Motion is restricted, but the shoulder is not as stiff as the frozen stage. This painful stage typically lasts 6-12 weeks.

  - Frozen Stage

  During the frozen stage, the pain usually eases up, but the stiffness worsens. The frozen stage can last 4-6 months.

  - Thawing Stage

  The thawing stage is gradual, and motion steadily improves over a lengthy period of time. The thawing stage can last more than a year.

• shoulder capsule becomes inflamed and stiff, greatly restricting motion and causing chronic pain

• joint becomes so tight and stiff that it is nearly impossible to carry out simple movements, such as raising the arm

• The movement that is most severely inhibited is external rotation of the shoulder

• stiffness and pain worsen at night

• usually dull or aching pain

• worsened with attempted motion

• limits to the active range of motion (range of motion from active use of muscles) are the same or almost the same as the limits to the passive range of motion (range of motion from a person manipulating the arm and shoulder)