Frozen shoulder in hyperthyroidism

Abstract

A patient who presented with bilateral frozen shoulders and unrecognized hyperthyroidism is described. Both frozen shoulder and the related shoulderhand syndrome may occur in this setting. These poorly understood rheumatic conditions often are complications of stroke, spinal cord injury, or diabetes. Dysfunction of the autonomic nervous system is thought to be of pathogenic importance. It is postulated that the close resemblance of hyperthyroidism to activation of the sympathetic nervous system may underlie its association with frozen shoulder and shoulder-hand syndrome.Thyroid disease may have rheumatic complications (1). A patient with bilateral frozen shoulders who had unrecognized hyperthyroidism prompted a review of this infrequently encountered association.Case report. The patient, a 62-year-old man, was referred for evaluation of restricted motion of the shoulders. Six months earlier he had begun losing weight, in spite of a good appetite. While moving into a new house, he noted unusual difficulty lifting boxes and furniture, and found he was having trouble getting out of a car. He discovered that he could not raise his arms beyond 90" and had discomfort over the anterior shoulder region when reaching backward. His weight, Submitted for publication August 20, 1986; accepted in revised form November 18, 1986. which had been 160 pounds, reached a low of 129, and then rose to 136 pounds. At the time of the visit, he was feeling well; his only complaints concerned the failure to regain all of his lost weight, and the restriction of shoulder motion. There was no history of shoulder problems, and no personal or family history of diabetes.An extensive diagnostic evaluation had been fruitless. On 2 occasions, serum levels of muscle enzymes were normal. A random serum glucose level was 101 mgldl and a fasting level was 96 mgldl. Radiographs of the shoulders, chest, and gastrointestinal tract gave normal results. Nerve conduction studies and electromyographic study of both upper extremities disclosed no evidence of neuropathy, myopathy, or radiculopathy. Muscle biopsy was not believed to be indicated. Thyroid tests were not done.At physical examination, he was a calm man who appeared exceedingly thin, but not ill. The blood pressure was 120/70 mm Hg, with an irregularly irregular pulse rate of 120 beats per minute. The hands were steady, and his skin was of normal texture. There was no exophthalmos, and no lid lag. His thyroid was not palpable. Both shoulders were limited to 45" of passive glenohumoral abduction, with virtually no internal or external rotation, and there was atrophy of the shoulder girdle musculature (Figure 1). Proximal strength was diminished in the upper, as well as the lower, extremities, but was still at or above 4/5 in all muscle groups. The deep tendon reflexes were normal.The remainder of the examination results were unremarkable.An electrocardiogram (EKG), obtained a few minutes later, showed sinus rhythm at a rate of 90;

Hyperthyroidism is a Risk Factor for Developing Adhesive Capsulitis of the Shoulder: A Nationwide Longitudinal Population-Based Study

“…Pathogenesis mechanisms have been proposed, such as endocrine, immunological, and inflammatory processes4. In addition, thyroid diseases, diabetes mellitus, Dupuytren contractures, breast cancer treatment, and autoimmune diseases have been associated with adhesive capsulitis in previous studies56789. Furthermore, patients diagnosed with myocardial infarctions and cerebral vascular diseases are reportedly at risk of adhesive capsulitis1011.…”

“…Overall, 137 patients with thyroid disorders were enrolled; of these, 15 had been diagnosed with adhesive capsulitis12. One case report described a subclinical hyperthyroid patient who was diagnosed with comorbid bilateral adhesive capsulitis7. The researchers stated that autonomic nervous system dysfunctions could play a key role in pathogenesis.…”

“…The researchers stated that autonomic nervous system dysfunctions could play a key role in pathogenesis. The activation of the sympathetic nervous system in hyperthyroid patients may underlie the association of adhesive capsulitis and shoulder-hand syndrome7. However, the definitive pathogenesis factor of adhesive capsulitis in hyperthyroid patients remains undetermined.…”

De behandeling van de frozen shoulder. Wel of geen fysiotherapie?

“…De primaire frozen shoulder heeft geen duidelijke oorzaak. De secundaire frozen shoulder kan het gevolg zijn van verschillende aandoeningen zoals een (triviaal) trauma, hemiplegie, cardiale problematiek, pulmonale tuberculose, epilepsie, diabetes mellitus en hyper-of hypothyreoı¨die (Lee, 1973;Wohlgethan, 1987). Ook wordt de secundaire vorm vaak geassocieerd met de ziekte van Dupuytren of de ziekte van Parkinson (Riley e.a., 1989).…”

The Role of Surgery in Frozen Shoulder

“…Stam 11 Upper limb trauma Arkkila et al 12 Diabetes Choy et al 13 ACTH deficiency Wohlgethan 14 Hyperthyroidism Bowman et al 15 Hypothyroidism Okamura and Ozaki 17 Reduced bone mineral density Lundberg and Nilsson 18 Osteopenia Tuten et al 19 Cardiac surgery Pineda et al 20 Cardiac catheterisation through the brachial artery Bruckner and Nye 21 Neurosurgery Patten and Hillel 22 Radical neck dissection Smith et al 23 Dupuytren's disease Riley et al 24 Parkinson's disease Boyle-Walker et al 25 Cardiac disease Wadsworth 26 Pulmonary disease Jayson 27 Stroke Bunker and Esler 28 Hyperlipidaemia Hutchinson et al 29 Treatment with matrixmetalloproteinase inhibitor THE JOURNAL OF BONE AND JOINT SURGERY idiopathic frozen shoulder, of whom 41 were available for follow-up after five to ten years. The mean duration of the condition was 30.1 months, but 61% had slight restriction of movement, although in only 6% was it felt to be a handicap.…”