Adhesive Capsulitis and PT Management Flashcards
What is usually the cause of Adhesive Capsulitis?
Typically Idiopathic (Primary Frozen Shoulder)
What are MSK conditions can contribute to Secondary Frozen Shoulder?
RA
OA
Trauma
Immobilization
What is the typical age of onset?
45 - 65 y/o
What systemic disease can lead to increased risk in developing Adhesive Capsulitis?
Thyroid Disease
Diabetes Mellitus
Clinical Signs and Symptoms During the Acute Phase?
Pain and protective muscle guarding that limit motion (usually ER and Abduction)
Sleep Disturbances and Night Pain
Tenderness on Palpation
Clinical Signs and Symptoms During the Subacute Phase?
Capsular Tightness (ER > Abduction > IR)
Pain felt at end of limited range
Clinical Signs and Symptoms During the Chronic Phase?
Capsular Pattern
Significant loss of Function
- Inability to reach overhead, outward or behind the back
Pain Often localized to the Deltoid Region
Characteristics of the “Freezing Stage” (Stage 2)
Persistent and more intense pain (even at rest)
Motion limited in all directions, cannot be restored with an intra-articular injection.
Typical Onset of the “Freezing Stage”
3-9 months
Characteristics of the “Frozen Stage” (Stage 3)
Pain only with movement
Significant Adhesion
Limited GH motions
Atrophy of:
- Deltoid
- Rotator Cuff
- Traceps
Typical Onset of the “Frozen Stage”
Occurs 9-15 months after onset
Characteristics of the “Thawing Stage” (Stage 4)
Minimal Pain
Significant Capsular Restrictions Noted
May see gradual improvement
Typical Onset of the “Thawing Stage”
15-24 Months after onset
What are some common Activity Limitations and Participation Restrictions presents?
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
Management during the Protection Phase?
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
What are some precautions to follow during the Protection phase?
If there is increase pain/irritability after therapy techniques that means, dosage was too strong or techniques should be modified
What is a main contraindication for appropriate tissue stretching?
Only apply tissue stretching
AFTER inflammation subsides
Management during the Controlled Motion Phase
ROM techniques progressed up to the point of pain
Progressively increase joint and soft tissue mobility
- Utilizing grade III and IV oscillations
During the controlled motion phase what do you do when a joint is irritable and gliding in certain direction is not tolerated?
Glide in the opposite direction until irritability decreases in which we can glide in the direction of restriction
What Faulty Mechanic is often found in patients with Frozen Shoulder?
Shoulder Hiking during elevation of the arm and at rest
Self-Mobilization Technique: Caudal Glide
Patient sitting on firm surface
Grasp Fingers under the edge
Patient away from stabilized arm
Self-Mobilization Technique: Anterior Glide
Sitting with both arms behind the body
Patient then leans body weight between both arms
Self-Mobilization Technique: Posterior Glide
Patient Prone and propped on elbows
Body weight shift downward between the arms
Management during the Return to Function Phase
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
When would/why and MUA be performed?
When no progress is made and physician orders ones.
During the Freezing Stage (Stage 2), can motion be restored via intra-articular injection
Unfortunately NO
During the Chronic Stage where is pain often felt?
Deltoid Region
What are the best glides according to NPTE guidelines to use for patients with Adhesive Capsulitis?
Posterior-Inferior Glides
