Adhesive Capsulitis CPG Flashcards
Adhesive Capsulitis CPG: Pathoanatomical features
E level: loss of passive motion in multiple planes, esp ER with arm at side and in varrying degrees of abd
Adhesive Capsulitis CPG: Risk factors
C level:
- Diabetes mellitus and thyroid disease
- 40-65yo female, prior episode of adhesive capsulitis in opposite arm
Adhesive Capsulitis CPG: Clinical Course
B level: stages progression of pain and mobility deficits lasting 12-18mo. Mild to mod mobility deficits may persist past that point, but little to no disability reported.
Adhesive Capsulitis CPG: Diagnosis/classification criteria
F level:
-gradual and progressive onset of pain and loss of AROM and PROM in elevation and rotation.
Adhesive Capsulitis CPG: Differential Diagnosis
F level:
consider other diagnosis if activity limitations or impairments of body function and structure are not consistent
Adhesive Capsulitis CPG: Exam: outcome measures
A level:
- DASH
- ASES
- SPADI
Adhesive Capsulitis CPG: Exam: activity limitation and participation restriction measures
F level: use easily reproducible activity limitation and participation restriction measures:
- pain during sleep
- pain and difficulty with grooming and dressing
- pain and difficulty with reaching
Adhesive Capsulitis CPG: Physical impairment measures
E level: measure pain, AROM and PROM of shoulder
Adhesive Capsulitis CPG: Interventions: corticosteroid injections
A level: intra-articular corticosteroid injections combined with shoulder mobility and stretching exercises are more effective for short term (4-6wk) pain relief and improved function
Adhesive Capsulitis CPG: Interventions: patient ed
B level: pt ed that:
- describes natural course of disease
- promotes activity modification to encourage functional, pain-free ROM
- matches the intensity of stretching to pts current level of irritability
Adhesive Capsulitis CPG: Interventions: modalities
C level:
can use shortwave diathermy, US, or e-stim combined with mobility and stretching exercises to reduce pain and improve shoulder ROM
Adhesive Capsulitis CPG: Interventions: Joint mobilization
C level: can use joint mobs to the GH jt to decrease pain and increase motion and function
Adhesive Capsulitis CPG: Interventions: translational manipulation
C level: can use transltaional manip under anesthesia directed to GH jt who are not responding to conservative interventions
Adhesive Capsulitis CPG: Interventions: stretching exercises
B level: instruct pts in stretching exercises, intensity determined by tissue irritability level.
Primary/Idiopathic adhesive capsulitis
not associated with systemic condition or history of injury.
Secondary adhesive capsulitis: extrinsic
Pathology not directly related to shoulder but results in painful and stiff shoulder
Ex: CVA, MI, COPD, liver disease, distal extremity fx
Secondary adhesive capsulitis: intrinsic
Known pathology of GH jt soft tissues or structures.
Ex: RTC tendinopathy, biceps tendinopathy, AC or GH jt arthopathy, proximal humeral or scapular fx
High irritability features
- high levels of pain >7/10
- consistent night or resting pain
- high levels of reported disability on standardized self report outcome tolls
- pain occurs before end ranges of active or passive movements
- AROM sig less vs PROM due to pain
Moderate irritability features
- mod levels of pain, 4-6/10
- intermittent night or resting pain
- mod levels of disability
- pain occurs at end ranges of AROM/PROM
- AROM similar to PROM
Low irritability features
- min levels of pain <3/10
- no night or resting pain
- min levels of reported disability
- pain occurs with overpressure into end range of PROM
- AROM same as PROM
High irritability interventions
Modalities: -heat and estim for pain self care/Pt ed: -POC, activity mod to limit inflammation and pain Manual: -low intensity jt mobs in pain free range Mobility exercise: -pain free PROM -pain free AAROM
Moderate irritability interventions
Modalities:
-heat and stim for pain as needed
Self care/pt ed:
-progress activities to gain motion and function without producing tissue inflammation and pain
Manual:
-mod intensity jt mobs into tissue resistance without producing post-tx tissue inflam and pain
Stretching:
-gentle to mod stretching without post-tx inflam and pain
NMR:
-integrate gains in mobility for reaching activities
Low irritability interventions
self-care/pt ed:
-performing high demand functional/recreation activities
Manual:
-end range jt mobs, high amplitude and long duration into tissue resistance
Stretching:
-into tissue resistance without producing post tx inflam and pain
NMR:
-integrate mobility gains into normal scapulohumeral mvmt for activities performed by pt for functional/recreational activities
