Adhesive Capsulitis (Frozen Shoulder): Stages, Symptoms, and Rehabilitation Techniques

What is another name for Adhesive Capsulitis?

Frozen shoulder or periarthritis.

What are the key characteristics of Adhesive Capsulitis?

Dense adhesions, capsular thickening, and capsular restrictions.

At what age does Adhesive Capsulitis typically onset?

Insidious onset between the ages of 40 and 60 years.

What is primary frozen shoulder?

Adhesive Capsulitis with no known cause.

What can lead to secondary frozen shoulder?

Conditions like rheumatoid arthritis, osteoarthritis, trauma, or immobilization.

What is the duration of the initial onset stage of Adhesive Capsulitis?

Less than 3 months.

What characterizes the initial onset stage of Adhesive Capsulitis?

Gradual onset of pain that increases with movement and is present at night.

What is common during the initial onset stage of Adhesive Capsulitis?

Loss of external rotation motion with intact rotator cuff strength

What occurs during the freezing stage of Adhesive Capsulitis?

- Persistent and intense pain even at rest, with limited motion in all directions.

- Motion is limited in all directions and cannot be fully restored with an intra-articular injection

How long does the freezing stage typically last?

Between 3 and 9 months.

What are the characteristics of the frozen stage?

Pain only with movement, significant adhesions, limited GH motions with substitute motions in the scapula, and muscle atrophy of the deltoid, rotator cuff, biceps, and triceps brachii

What is the duration of the frozen stage?

Between 9 and 15 months.

What characterizes the thawing stage of Adhesive Capsulitis?

Minimal pain, no synovitis, significant capsular restrictions, and gradual improvement in motion.

How long can the thawing stage last?

From 15 to 24 months or longer.

**Some patients never regain normal ROM

What are the phases of management for Adhesive Capsulitis?

Phase 1 (Protection), Phase 2 (Controlled motion), Phase 3 (Return to functional).

What can be provided during Phase 1 Management?

A sling to provide rest and minimize pain

What type of ROM exercises are suggested in Phase 1?

Passive/assisted ROM within a pain-free range.

What type of joint glides are beneficial in Phase 1 Management?

- Passive joint distraction and glides (Grade I and II in pain-free position)

- Posterior-inferior glide is best

- Posterior glide to improve external rotation

What is a recommended exercise during Phase 1 management?

Pendulum exercise.

What is a key exercise in Phase 2 management?

Self-assistive ROM such as wand exercises or hand slides on a table.

What type of joint mobilization techniques are used in Phase 2?

- Passive joint mobilization techniques (Grade III sustained or Grade III and IV oscillations).

- Self-mobilization (caudal, anterior, and posterior glide)

What should be corrected during management of Adhesive Capsulitis?

Faulty postures.

What type of strengthening can be included in Phase 2 Management?

GH internal/external rotation strengthening

What exercises can be progressed in Phase 3 Management?

Stretching & strengthening exercises as the joint tissue tolerates

What should be done if capsular tissue is still restricting ROM in Phase 3 Management?

Apply vigorous manual stretching and joint mobilization techniques.

What is recommended if the joint is highly irritable?

Glide in the opposite direction of restriction until pain decreases.