Adhesive Capsulitis

Adhesive Capsulitis (Frozen Shoulder)

Condition characterized by dense adhesions, capsular thickening, and capsular restrictions in the shoulder.

Primary vs. Secondary Adhesive Capsulitis

Primary is insidious (ages 40-60)
Secondary results from prior pain/immobilization (e.g., RA, OA, trauma).

Stage 1: Initial Onset Stage

Duration <3 months
Gradual pain increase
Night pain
Loss of ER with intact RTC strength

Stage 2: Freezing Stage

Duration 3-9 months
Persistent intense pain at rest and limited ROM in all directions.

Stage 3: Frozen Stage

Duration 9-15 months
Pain only with movement, significant adhesions, scapular substitution
Atrophy of deltoid, RTC, biceps, and triceps

Stage 4: Thawing Stage

Duration 15-24+ months
Minimal pain and no synovitis
Significant capsular restrictions from adhesions

Phase 1 Management (Protection Phase)

Focuses on pain relief
Pain-free PROM/AAROM
Pendulum exercises
Grade I/II glides (posterior to improve ER)

Phase 2 Management (Controlled Motion)

Self assistive ROM and mobilization
Grade III/IV joint mobilizations
Postural correction
GH rotation strengthening

Phase 3 Management (Return to Function)

Stretching and strengthening as tissue tolerate
Vigorous manual stretching and joint mobilizations if needed

Irritable Joint Glide Principle

Glide in the opposite direction until irritability decreases

Non Irritable Joint Glide Principle

Glide in the direction of restriction