Adhesive Capsulitis

Question 1

What is Adhesive Capsulitis?

What is the average duration?

Answer 1

condition w. pain and stiffness in the shoulder associated w/ sleep deprivation, anxiety, and disability

30.1 months

Question 2

What population is mostly affected by Adhesive Capsulitis?

Answer 2

• more likely in patients w/ diabetes or thyroid disease
• primarily 40-60 year olds
• females more than males

Question 3

What is the cause of Adhesive Capsulitis?

What does it result in?

Answer 3

Cause is unknown but histological changes include presence of inflammatory cytokines, fibroblasts and lymphocytes

results in:

• hardening of redundant axillary folds
• synovial capsule thickening
• contracture of GH joint
• dense adhesions on the synovial capsule
• significant loss of AROM/PROM

Question 4

What MRI findings are common with Adhesive Capsulitis?

Answer 4

• thickening of the CH ligament
• thickening of the joint capsule and synovial membrane
• fluid distention of the bursa in the subscapularis recess
• synovial abnormalities around long head of biceps tendon
• significant loss of fluid volume in joint capsule

Question 5

What are the stages of Adhesive Capsulitis?

Answer 5

Stage 1: 0-3 months, non-capsular limitations, pain with A/PROM

Stage 2: “freezing”, 3-9 months, capsular pattern limitation

Stage 3: “frozen”, 9-15 months, high irritability, rigid end feel

Stage 4: “thawing”. 15-24 months, low irritability, gradual return ROM

Question 6

How would patients with Adhesive Capsulitis typically present?

Answer 6

• gradual and progressive onset of pain
• pain at end ranges of movements
• patients also present w/ painful and restricted A/PROM in both elevation and rotation that occurs for at least 1 month
• functional activities such as reaching overhead, behind the back, or out to the side become difficult due to pain or stiffness

Question 7

What is the capsular pattern of the GH joint?

Answer 7

ER limitations > ABD limitations > IR limitations

Question 8

What treatment options are there for Adhesive Capsulitis patients?

Answer 8

• wait and see
• PT
• Oral Steroid
• Corticosteroid injections
• Manipulation under anesthesia
• Arthroscopy

Question 9

What is the most common duration of symptoms in patients who use the wait and see method for getting better from Adhesive Capsulitis?

Answer 9

4-36 months but 94% of pts. will see some return in ROM

Question 10

What is the most common duration of symptoms in patients who use Physical Therapy and medication for getting better from Adhesive Capsulitis?

Answer 10

3. 8 months w/o surgery

12. 4 months w/ surgery

Question 11

True or False: Oral steroids were found to be less effective then corticosteroid injections when coupled with PT for long term benefits.

Answer 11

True

Question 12

True or False: Patients who choose to do surgery will have the same outcome as PT but will see decrease in ROM deficits.

Answer 12

False, patients undergoing surgery had greater ROM deficits

Question 13

What is considered Level A evidence for treating Adhesive Capsulitis?

Level B Evidence?

Level C?

Answer 13

Steroid injections combined w/ PT

Patient education and stretching

Modalities and mobilizations/manipulations

Question 14

What is the prognosis for Adhesive Capsulitis patients?

Answer 14

Prognosis is generally very good and most will see their ROM return to normal, but some (~10%) with be unsuccesful with PT and require surgery