Adhesive Capsulitis

adhesive capsulitis is Synovitis of GH jt capsule & progresses from

↑ angiogenesis & neural growth → ↑ pain response

Fibrosis & Contracture of GH jt/jt capsule

Manifesting in Severe Mobility restrictions of GH jt

Primary or Idiopathic Adhesive Capsulitis is a global limitation of

humeroscapular motion

Contracture & loss of compliance of GH jt capsule

2ndary Adhesive Capsulitis potentially from System causes of

Thyroid

Diabetes Type I & II

2ndary Adhesive Capsulitis potentially stems from Intrinsic causes such as musculotendinous pathology including

GH Conditions

RC tendinopathy or cuff tears

2ndary Adhesive Capsulitis potentially stems from Extrinsic causes such as

Other health conditions

CVA

Adhesive Capsulitis Natural History/typical course lasts around

Average of 30 months

Range 12-42 months (1-3.5 yrs)

Clinical presentation of adhesive capsulitis is typically Insidious onset from wks-months leading to gradual loss of motion & ↑ in shoulder pain. What is typical population?

Ages 45- 65 years old

Females>Males

Clinical Presentation sxs of adhesive capsulitis

Pain w/ shoulder motion & at rest

Worse at END of available range (multiplanar)

Severe stiffness

Clinical Presentation of adhesive capsulitis; clinical exam signs

Multiplane loss of shoulder motion A/PROM

ER at 0

Adhesive capsulitis Stage I-II is what phase?

Freezing Phase (painful phase)

Adhesive capsulitis is commonly misdiagnosed as SAPS when in Stage I. signs and sxs of Stage 1

Spontaneous onset of shoulder pain

Sharp pain at end ranges

Achy pain at rest

Sleep Disturbances

Stage I can last

1-3 months each

stage II frozen shoulder signs & sxs

Pain same as stage I (lower level)

Gradually ↑ stiffness develops

Primarily loss of (tightening of anterior capsule) ER, Abduction, Flexion

Stage II can last for

3-9 months each

Stage III Frozen Phase (Stiff Phase) signs & sxs are at their worst, they include developed ROM limitations in

ER, abduction, flexion

Pain at end range

stiffness more pronounced: fibrosis of jt capsule present

Stage III lasts for

9-15 months

Stage IV - Thawing Phase (Resolution Phase) is a gradual functional recovery. Signs & sxs of stage IV include progressive ↑ of ROM due to

capsular remodeling (end range stretching TERT, LLD, daily)

Normal use of arm & shoulder

Some pts may not recover full ROM; especially ER

Stage IV thawing phase lasts

15-24 months

adhesive capsulitis management for pain

Manual Therapy

Exercise

Corticosteroid Injections (intra-articular)

adhesive capsulitis management for fibrosis is mobility w/ gradual

progressive stretching w/in pain tolerance

Max Total End Range Time (TERT)

for the early stages of adhesive capsulitis, your management approach should follow

irritability, dial back

treatment goals for adhesive capsulitis

1st. To relieve pain

2nd. Restore motion (based on goals)

3rd. Restore function (greater facilitator of capsular changes)

patient education for adhesive capsulitis should include

Emphasis on patient self management (TERT)

Condition will often take months to resolve: nature of disease process

activity modification

Active & passive stretching goals for adhesive capsulitis to maintain & regain ROM. Approach changes w/ irritability. For higher irritability use

Short hold Times 5-10 seconds

Active & passive stretching goals for adhesive capsulitis to maintain & regain ROM. Approach changes w/ irritability. For lower irritability use

Longer Hold Times

10-60 sec

Low Load Long Duration: Multiple minutes

Active & passive stretching frequency should be

4x-5x daily

Active & passive stretching intensity

Discomfort is ok

Stretching slightly past point of pain is necessary to make forward progression in ROM

Active & passive stretching positions initially performed in

supine; stabilizes scapula to bias GH jt capsule

Therapy Frequency in early rehab for adhesive capsulitis

↑ frequency 1-2x week

Focus on ↓ pain

Find exercises that are most effective for pt

Track progress, Inform prognosis

Therapy in later rehab for adhesive capsulitis has an emphasis on restoring ROM, usually a slow process, but gradually ↑

stretching duration & intensity

Progress stretching to new ROM

Reduce Frequency 1x every 2 wks-month. Track progress

Most cases of frozen shoulder respond to non-operative treatment, but operative management may become necessary if

conservative measures are not effective

Indications for surgery for adhesive capsulitis include:

Persistent global stiffness

Pain w/ little improvement

Despite at least 4-6 months of nonoperative care

Operative treatment for adhesive capsulitis options include

Closed manipulation under anesthesia

Arthroscopic capsular releases (thinning of capsule & range jt): be seen very often for 2 wks

when documenting adhesive capsulitis tie the impairment to

the pts everyday function