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Rheumatoid factor (RF)
8%
36/427
C-reactive protein (CRP)
10%
42/427
Free T4
Hemoglobin A1C
70%
299/427
Lactic acid
1%
6/427
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Patients with adhesive capsulitis are more likely to have diabetes mellitus (DM), in which case, they would have an elevated hemoglobin A1C (Answer 4).Adhesive capsulitis of the shoulder is characterized by loss of shoulder range of motion, both passively and actively. It is thought to be driven by an inflammatory process that leads to a proliferation of scar tissue within the capsule. This can occur post-traumatically, post-surgically, or idiopathically. As an orthopedic surgeon, it is important to recognize cases of adhesive capsulitis and inquire further about the patient's medical history including that of diabetes, hypothyroidism, and other metabolic/endocrine issues. The first line treatment for adhesive capsulitis is physical therapy +/- a glenohumeral joint injection. If conservative care is unsuccessful, manipulation under anesthesia can be attempted, followed by an arthroscopic capsular release. Yian et al. published a retrospective review highlighting the effects of glycemic control on the prevalence of diabetic adhesive capsulitis. They noted that patients with adhesive capsulitis were 1.5x more likely to have diabetes, with that number increasing to 2x in insulin-dependent diabetics. They also noted a correlation between the duration of diabetes and the development of adhesive capsulitis.Le Lievre et al. and Murrell looked at outcomes after arthroscopic capsular release for adhesive capsulitis. This was performed in 43 patients with all having significant improvement in shoulder function and pain. They concluded that with this approach, at final follow-up, shoulder motion and function could be comparable to the contralateral side. Hsu et al. reviewed current concepts in adhesive capsulitis, starting with etiology and pathogenesis. They highlight the relationship of adhesive capsulitis with multiple medical comorbidities including diabetes. They discuss the natural history and treatment, which tends to be mostly conservative.Incorrect Answers:Answer 1: Rheumatoid factor may be elevated in cases of rheumatoid arthritis or other similar inflammatory arthropathies. Answer 2: C-reactive protein may be elevated in cases of infection or other inflammatory arthropathies. Answer 3: While hypothyroidism has been linked to adhesive capsulitis, elevated free T4 would be representative of hyperthyroidism.Answer 5: Elevated lactic acid may be seen in cases of gout.
3.3
(3)
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