Which joint movement is restricted in a patient with pericapsulitis of shoulder?

JIPMER Nursing Officer-2017

Medical & Surgical Nursing

Easy

Appeared in: JIPMER Nursing Officer-2017

Explanation

Pericapsulitis, or adhesive capsulitis (frozen shoulder), is characterized by a specific, predictable loss of motion known as the 'capsular pattern'.
The classic capsular pattern for the shoulder joint involves the greatest restriction in external rotation, followed by abduction, and then internal rotation.
Among the given choices, abduction is the most significantly restricted movement according to this established pattern, making it the correct answer.

Option A: Adduction involves moving the arm towards the midline of the body. In adhesive capsulitis, this movement is typically the least affected and often remains close to normal.
Option C: While forward flexion is limited in adhesive capsulitis, the degree of restriction is less severe than that of both external rotation and abduction.
Option D: Shoulder extension is also part of the restricted movements in adhesive capsulitis, but like flexion, it is less limited than abduction and external rotation.

Clinical Relevance

Nursing practice connection: Use the key finding related to Capsular pattern of restriction in adhesive capsulitis (frozen shoulder) to guide bedside assessment, documentation, and the next nursing action.
Recognizing the capsular pattern is a crucial diagnostic skill for nurses and physiotherapists, as it helps distinguish adhesive capsulitis from other shoulder conditions like rotator cuff tears or impingement syndrome.
Patient education is vital. Nurses should explain that recovery is slow and requires adherence to physical therapy to regain motion and manage pain effectively.
What if? If a patient presented with significant shoulder pain but had a full passive range of motion (i.e., the examiner could move the arm fully), the diagnosis would likely not be adhesive capsulitis. This presentation points more towards tendonitis or bursitis, where inflammation causes pain on active movement but does not typically cause mechanical stiffness of the joint capsule itself.

How to Approach the Question

First, identify the key term 'pericapsulitis of shoulder,' which is a synonym for adhesive capsulitis or 'frozen shoulder'.
Recall the specific 'capsular pattern' of joint restriction associated with this condition. This is a foundational concept in musculoskeletal assessment.
The pattern for the shoulder is a predictable hierarchy: External Rotation is the most limited, followed by Abduction, and then Internal Rotation.
Compare the given options (Adduction, Abduction, Flexion, Extension) to this established pattern.
Since External Rotation is not an option, identify the next most restricted movement in the hierarchy, which is Abduction.
Select Abduction as it is the most restricted movement among the choices provided.

Concept Tested & Keywords

Concept Tested: Capsular pattern of restriction in adhesive capsulitis (frozen shoulder).
Stem keywords: pericapsulitis, shoulder, joint movement, restricted
Lead-in keywords: Which
Negative lead-in flag: false

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E6 Medicine Macleod Clinical Examination 15e p. 313-315