Adhesive Capsulitis

Question 1

Definition

Answer 1

Fibrosis of GH jt capsule w/ chronic inflam.

Question 2

Primary

Answer 2

no specific event, chronic inflam response w/ fibroblast proliferation.

Question 3

Secondary

Answer 3

after surgery/injury, may be associated w/ another condition.

Question 4

Proposed pathology

Answer 4

Subscap tightness: greater dec in ER PROM at 45° ABD (versus at 90°).
Multiregional synovitis w/ inflammation.
Capsular fibrosis/contracture: dec capsule volume due to tightening.
Fwd head: HH elevated & anterior.
Fascial restrictions & trigger points.

Question 5

Risk factors

Answer 5

Hx of adhesive capsulitis in contra arm
Age 40-65, Female > male
Diabetes, Dupuytren’s contracture
Thyroid disease, Trauma, Trigger finger
MI
Prolonged immob
Autoimmune disease

Question 6

Signs/symptoms

Answer 6

Gradual onset, Progressively worsening pain, Pain @ end-range, Night pain, Sleep disturbance, Difficulty reaching OH, behind back, out to side.
Shrug sign w/ GH elevation: compensate w/ upper traps.
Capsular pattern.

Question 7

Shrug sign w/ both A/PROM indicates…

Answer 7

adhesive capsulitis

Question 8

Shrug sign w/ AROM only indicates…

Answer 8

impingement

Question 9

Capsular pattern

Answer 9

ER > ABD > IR

Question 10

Rule in if

Answer 10

Age 40-65.
PROM decrease in multiple directions.
PROM to end-range = reproduce pain.
Jt motions decrease in all directions.

Question 11

Rule out if

Answer 11

Arthritis present.
PROM normal.
PROM IR/ER increase as hum ABD from 45° to 90°.
ULTT reproduces symptoms.
Pain reproduced w/ palpation.

Question 12

Stage 1

Answer 12

sharp pain @ end-range, achy pain at rest, mis-dx as impingement due to good ROM

Question 13

Stage 2

Answer 13

Freezing or Painful Stage
gradual decrease ROM due to pain, synovitis, decreased ROM under anesthesia.
In the process of getting tighter; less ROM with more pain.

Question 14

Stage 3

Answer 14

Frozen Stage
pain, loss of ROM, progressive fibrosis.
VERY stiff, but less irritable. Now we may be able to stretch/mob w/o making worse.

Question 15

Stage 4

Answer 15

Thawing Stage
pain begins to resolve, signficiant stiffness persists.
Where we need to be to really start tx w/o making it worse.

Question 16

Non-op tx

Answer 16

corticosteroid injections, oral corticosteroids, NSAIDs, PT.
Pt edu: describe natural course of disease, match intensity to current level of irritability.
Modalities & joint mobs
Stretching & strengthening: only in pain-free range.

Question 17

Op tx

Answer 17

manipulation under anesthesia, arthroscopic capsular release, open surgical release, brisement.

Question 18

Tx for painful stage

Answer 18

Postural positioning
Manual techniques - to relieve musc involvement.
Modalities - primarily to address inflam (secondary for pain).
Grade 1/2 mobs - long axis distraction.
Maintain existing ROM.

Question 19

Tx for thawing stage

Answer 19

AAROM - dowel rod stuff, table slides, etc.
Aggressive ROM, HEP for ROM.
Grade 3/4 mobs
Ultrasound - ant/inf capsule.
Strengthen - RC & periscap.