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A patient is treated for adhesive capsulitis in an outpatient physical therapy clinic. Which of the following patients would be MOST at risk for this diagnosis?

1.  50-year-old female with hypothyroidism
2.  60-year-old male with a T8 spinal cord injury
3.  70-year-old female with Ehlers-Danlos syndrome
4.  80-year-old male with acromioclavicular joint osteoarthritis

Transcript

Welcome back to the Scorebuilders’ Question and Answer Podcast! This podcast provides members of the Scorebuilders’ team with the opportunity to explore challenging multiple-choice examination questions with students actively preparing for the licensing examination. My name is Scott Giles and I will be your host for today’s journey.

Ready? Let’s go!

A patient is treated for adhesive capsulitis in an outpatient physical therapy clinic. Which of the following patients would be MOST at risk for this diagnosis?

1.  50-year-old female with hypothyroidism
2.  60-year-old male with a T8 spinal cord injury
3.  70-year-old female with Ehlers-Danlos syndrome
4.  80-year-old male with acromioclavicular joint osteoarthritis

Adhesive Capsulitis
Adhesive capsulitis (also known as “frozen shoulder”) is an enigmatic shoulder disorder characterized by inflammation and fibrotic thickening of the joint capsule of the shoulder. 

To determine the patient most at risk for adhesive capsulitis, there are three factors to consider.

• Patient age
• Biological sex
• Comorbidity

Patient age - adhesive capsulitis occurs more in the middle-aged population (i.e., 40-65 years old),

Biological sex - females having a greater incidence than males

Comorbidity – the four presented conditions to consider are:

• Hypothyroidism
• T8 spinal cord injury
• Ehlers-Danlos syndrome
• Acromioclavicular joint osteoarthritis

In each of the options, we will list the terms - Patient age, Biological sex, and Comorbidity. A checkbox placed next to each term will determine if the presented information is consistent with adhesive capsulitis.

Let’s explore each of the options:

Option 1 - 50-year-old female with hypothyroidism

Patient age: 50-year-old

A 50-year-old patient is considered to be middle-aged which is consistent with the peak incidence of developing adhesive capsulitis.

Biological sex: Female

Females are more likely to develop adhesive capsulitis than males.

Comorbidity: Hypothyroidism

Hypothyroidism
Hypothyroidism, also known as an underactive thyroid, is a condition where the thyroid gland does not produce enough thyroid hormones. These hormones regulate metabolism, growth, and other bodily functions. 

Thyroid disorders are known to increase the risk for adhesive capsulitis

Option 2 - 60-year-old male with a T8 spinal cord injury

Patient age: 60-year-old

A 60-year-old patient is considered to be middle-aged which is consistent with the peak incidence for developing adhesive capsulitis.

Biological sex: Male

Males are less likely to develop adhesive capsulitis than females. 

Comorbidity: T8 spinal cord injury

T8 Spinal Cord Injury
T8 spinal cord injury refers to damage to the spinal cord at the eighth thoracic vertebra, leading to potential loss of function and sensation below that level, including in the trunk and lower extremities.

The presence of a T8 spinal cord injury would not increase the risk for adhesive capsulitis.

Option 3 - 70-year-old female with Ehlers-Danlos syndrome

Patient age: 70-year-old

A 70-year-old patient is beyond the age of peak incidence for developing adhesive capsulitis.

Biological sex: female

Females are more likely to develop adhesive capsulitis than males.

Comorbidity: Ehlers-Danlos syndrome

Ehlers-Danlos Syndrome
Ehlers-Danos syndrome is a group of inherited connective tissue disorders characterized by joint hypermobility, skin fragility, and other systemic abnormalities.

The presence of Ehlers-Danlos syndrome would not increase the risk for adhesive capsulitis.

Option 4 - 80-year-old male with acromioclavicular joint osteoarthritis

Patient age: 80-year-old

An 80-year-old patient is well beyond the age of peak incidence for developing adhesive capsulitis.

Biological sex: Male

Males are less likely to develop adhesive capsulitis than females. 

Comorbidity: Acromioclavicular joint osteoarthritis

Acromioclavicular Joint Osteoarthritis
Acromioclavicular joint osteoarthritis is a degenerative condition where the cartilage in the joint (i.e., acromion and clavicle) wears down causing pain, stiffness, and limited movement.

Though osteoarthritis can lead to mobility restrictions in the associated joint, osteoarthritis of the AC joint is unlikely to cause significant range of motion loss in the shoulder joint complex.

The correct answer is Option 1

Let’s explore the all student data:
65% of students selected Option 1, 50-year-old female with hypothyroidism - the correct response
5% of students selected Option 2, 60-year-old male with a T8 spinal cord injury
5% of students selected Option 3, 70-year-old female with Ehlers-Danlos syndrome
25% of students selected Option 4, 80-year-old male with acromioclavicular joint osteoarthritis

System Classification
This question is a Musculoskeletal System question which represents approximately 27% of all exam items.

Content Outline Classification
This question is a Foundations for Evaluation, Differential Diagnosis, and Prognosis question which represents approximately 33% of all exam items.

Level Classification
This question is a Level 2 question since the question requires students to integrate numerous pieces of information or to apply knowledge in a given clinical scenario. Remediation of Level 2 questions occurs by increasing flexibility with academic content and by carefully analyzing decision making processes when answering applied examination questions.

Academic Focus Area
Looking to review related academic content? Check out pages 128 and 166-167 in PTEXAM: The Complete Study Guide.

Thanks for joining us on the Scorebuilders Q and A podcast! See you next week!