Adhesive Capsulitis and PT Management

Question 1

What is usually the cause of Adhesive Capsulitis?

Answer 1

Typically Idiopathic (Primary Frozen Shoulder)

Question 2

What are MSK conditions can contribute to Secondary Frozen Shoulder?

Answer 2

RA
OA
Trauma
Immobilization

Question 3

What is the typical age of onset?

Answer 3

45 - 65 y/o

Question 4

What systemic disease can lead to increased risk in developing Adhesive Capsulitis?

Answer 4

Thyroid Disease
Diabetes Mellitus

Question 5

Clinical Signs and Symptoms During the Acute Phase?

Answer 5

Pain and protective muscle guarding that limit motion (usually ER and Abduction)

Sleep Disturbances and Night Pain

Tenderness on Palpation

Question 6

Clinical Signs and Symptoms During the Subacute Phase?

Answer 6

Capsular Tightness (ER > Abduction > IR)

Pain felt at end of limited range

Question 7

Clinical Signs and Symptoms During the Chronic Phase?

Answer 7

Capsular Pattern

Significant loss of Function
- Inability to reach overhead, outward or behind the back

Pain Often localized to the Deltoid Region

Question 8

Characteristics of the “Freezing Stage” (Stage 2)

Answer 8

Persistent and more intense pain (even at rest)

Motion limited in all directions, cannot be restored with an intra-articular injection.

Question 9

Typical Onset of the “Freezing Stage”

Answer 9

3-9 months

Question 10

Characteristics of the “Frozen Stage” (Stage 3)

Answer 10

Pain only with movement

Significant Adhesion

Limited GH motions

Atrophy of:
- Deltoid
- Rotator Cuff
- Traceps

Question 11

Typical Onset of the “Frozen Stage”

Answer 11

Occurs 9-15 months after onset

Question 12

Characteristics of the “Thawing Stage” (Stage 4)

Answer 12

Minimal Pain

Significant Capsular Restrictions Noted

May see gradual improvement

Question 13

Typical Onset of the “Thawing Stage”

Answer 13

15-24 Months after onset

Question 14

What are some common Activity Limitations and Participation Restrictions presents?

Answer 14

Inability to reach overhead
Fastening a Bra
Reach hand into pack pocket of pants
Self-Grooming (Combing, brushing teeth)
Bringing utensils to mouth
Lifting heavy objects above shoulder level

Question 15

Management during the Protection Phase?

Answer 15

Patient Education!

Controlling:
- Pain*
- Edema*
- Muscle Guarding

Gentle joint oscillations as soon as patient is able to tolerate movement, Pendulum Exercise

Maintaining Soft tissue and mobility

Question 16

What are some precautions to follow during the Protection phase?

Answer 16

If there is increase pain/irritability after therapy techniques that means, dosage was too strong or techniques should be modified

Question 17

What is a main contraindication for appropriate tissue stretching?

Answer 17

Only apply tissue stretching

AFTER inflammation subsides

Question 18

Management during the Controlled Motion Phase

Answer 18

ROM techniques progressed up to the point of pain

Progressively increase joint and soft tissue mobility
- Utilizing grade III and IV oscillations

Question 19

During the controlled motion phase what do you do when a joint is irritable and gliding in certain direction is not tolerated?

Answer 19

Glide in the opposite direction until irritability decreases in which we can glide in the direction of restriction

Question 20

What Faulty Mechanic is often found in patients with Frozen Shoulder?

Answer 20

Shoulder Hiking during elevation of the arm and at rest

Question 21

Self-Mobilization Technique: Caudal Glide

Answer 21

Patient sitting on firm surface

Grasp Fingers under the edge

Patient away from stabilized arm

Question 22

Self-Mobilization Technique: Anterior Glide

Answer 22

Sitting with both arms behind the body

Patient then leans body weight between both arms

Question 23

Self-Mobilization Technique: Posterior Glide

Answer 23

Patient Prone and propped on elbows

Body weight shift downward between the arms

Question 24

Management during the Return to Function Phase

Answer 24

Progressively increasing flexibility and strength
- If capsular tissue still restricting ROM Vigorous manual techniques may be applied

Preparing for functional demands
- Replicating job demands: heavy pushing-pulling-carrying-lifting

Question 25

When would/why and MUA be performed?

Answer 25

When no progress is made and physician orders ones.

Question 26

During the Freezing Stage (Stage 2), can motion be restored via intra-articular injection

Answer 26

Unfortunately NO

Question 27

During the Chronic Stage where is pain often felt?

Answer 27

Deltoid Region

Question 28

What are the best glides according to NPTE guidelines to use for patients with Adhesive Capsulitis?

Answer 28

Posterior-Inferior Glides