Adhesive capsulitis Flashcards
What is Adhesive capsulitis
Frozen shoulder
Inflammation and fibrotic thickening of anterior joint capsule of shoulder, capsule adheres to humeral head and has contractures
Most limited external rotation, abduction, internal rotation Glenohumeral passive and active range of motions
Within joint capsule inflammation causes fibers is adhesions and capsule thickens, decrease space leads to decrease synovial fluid further irritating glenohumeral joint
Spontaneous recovery in 12 to 24 months
What causes primary adhesive capsulitis
Primary occur spontaneously, unknown ideology, associated with
- diabetes mellitus
- thyroid disorders, hyperthyroidism
- autoimmune disorders,
- cardio pulmonary conditions
What causes secondary adhesive capsulitis
Underlying condition
Trauma, immobilization, complex regional pain syndrome, rheumatoid arthritis, abdominal disorders, psycho genic disorders
Intrinsic disorders me initiate process such as supraspinatus tendon Nightes, partial tear of rotator cuff, bicipital tendonitis
Adhesive capsulitis patient
More common in middle aged >40yrs
females more than males
Adhesive capsulitis prevalence and incidence
2% population in US
11% diagnosed with diabetes Mellitus
10 to 15% develop bilateral
Adhesive capsulitis acute phase presentation
Pain radiates below elbow and awakens patient at night
Passive range of shoulder motion limited due to pain and guarding
Adhesive capsulitis chronic phase presentation
Pain localized around lateral brachial region
Patient is not awakened by pain next
passive range limited due to capsular stiffness
Pain with loss of glenohumeral motion, restricted elevation and lateral rotation
How is adhesive capsulitis diagnosed
Imaging
Arthrogram detect volume of fluid and joint capsule
Normal glenohumeral joint hold 16 to 20 mL of fluid
Adhesive capsulitis typically holds 5 to 10 mL of fluid
Greatest restriction of glenohumeral motion and abduction and lateral rotation, but all motion planes affected typically
Inferoanterior joint capsule tightness and pain with stretching
restrictions with passive and active range of motion
What is medical management of adhesive capsulitis
- Pharmacological intervention controls pain acetaminophen, NSAIDs, longer acting analgesics, narcotics
- Corticosteroid injection to help recovery of motion
- Manipulation under anesthesia
- Surgery to break up adhesions or release muscles adhered to capsule if conservative management fails
What is physical therapy management of adhesive capsulitis
Acute phase icing, superficial heat, gentle Joint mobilization, progressive strengthening, pendulum exercises, isometric strengthening
Chronic Faze ultrasound, grade 3 and four mobilization to increase extensibility, PNF to restore painless functional range of motion
3 to 5 months of outpatient PT
Adhesive capsulitis HEP
Acute phase self stretching but avoid abduction To avoid damaging subacromial tissue
Chronic phase emphasize self stretching, progressive exercises, posture management, PNF, and other exercises Like pendulums and wall climbing to improve range of motion
Adhesive capsulitis long-term prognosis
Spontaneous recovery 12 to 24 months
Full recovery overtime
7 to 14 patients experience permanent loss of range but does not impaired functional ability
Adhesive capsulitis differential diagnosis
Loss of range of motion passive and active and capsular pattern, persists 12 to 24 months for spontaneous recovery
Acute bursitis intense pain and lateral break your region, often secondary to calcific tendinitis, pain produced in abduction more than 60° and flexion more than 90°, only last a few days
stage II of adhesive capsulitis
Freezing stage
- present for 3-9 months
- progressive loss of shoulder movement and an increase in pain (especially at night)
- decreased lateral (external) rotation and abduction; still has some range of movement, but it is limited by both pain and stiffness
- pain that disrupts sleep
stage I of adhesive capsulitis
Prefreezing”
- symptoms for 1 to 3 months, and they’re getting worse.
- shoulder usually aches when you’re not using it, but the pain increases and becomes “sharp” with movement
- begin limiting shoulder motion and protect the shoulder by using it less
- movement loss is most noticeable in ER, but may start to lose motion in flexion or IR
- Pain is the hallmark feature of this stage; you may experience pain during the day and at night
stage III of adhesive capsulitis
Frozen stage
- symptoms have persisted for 9 to 14 months
- greatly decreased range of shoulder movement (ER, abduction, IR)
- early part of this stage, there is still a substantial amount of pain
- end of this stage, pain decreases, with the pain usually occurring only end range
stage IV of adhesive capsulitis
Thawing stage
- had symptoms for 12 to 15 months
- big decrease in pain, especially at night
- still have a limited range of movement, but your ability to complete your daily activities involving overhead motion is improving at a rapid rate
PT intervention for stage I and II
phase 1 and 2 = maintain as much range of motion as possible, reduce your pain.
- ROM Exercises and manual therapy maintain shoulder movement
- Modalities. heat and ice treatments (modalities) to help relax the muscles prior to other forms of treatment.
- Home-exercise program. gentle home-exercise program designed to help reduce your loss of motion, warn you that being overly aggressive with stretching in this stage may make your shoulder pain worse.
- Pain medication. injection of a safe anti-inflammatory and pain-relieving medication; injections don’t provide longer-term benefits for range of motion and don’t shorten the duration of the condition, they do offer short-term pain reduction.
PT goals and interventions for stage III
phase 3 = return of motion.
- Stretching techniques. more intense stretching techniques to encourage greater movement and flexibility.
- Manual therapy. take your manual therapy to a higher level, encouraging the muscles and tissues to loosen up.
- Strengthening exercises. may begin strengthening exercises targeting the shoulder area as well as your core muscles.
PT goals and interventions for stage IV
phase 4 = return of “normal” shoulder body mechanics and your return to normal, everyday, pain-free activities.
- Stretching techniques. focus on the specific directions and positions that are limited
- Manual therapy. Your physical therapist may perform manual therapy techniques in very specific positions and ranges that are problematic, focus on eliminating the last of your limitations.
- Strength training. related to any weakness to help you perform work or recreational tasks.
- Return to work or sport. address movements and tasks that are required in your daily and recreational life.
higher incidence
higher age
female
diabetes,
hyperthyroidism,
upper extremity paresis, brachial plexus injury,
Parkinson’s disease, and
repetitive strain injuries of the shoulder have a higher overall incidence of adhesive capsulitis.
