DPT 5010: Adhesive Capsulitis (For Exam 3) Flashcards
Review Normal Mechanic- Roll & Glide of GH Joint
Flexion- superior roll; inferior glide
Abduction- superior roll; inferior glide
IR= anterior roll; posterior glide
ER= posterior roll; anterior glide
True Capsulitis: Identified by…
Restricted passive motion in multiple planes, characterized by capsular pattern: ER > ABD > IR
- Inflammation of shoulder from impingement, small RC tear, etc.
- leads to pt not moving shoulder
- leads to “capsuloligamentous inflammation”
- capsule becomes thickened & fibrotic & fixed to humeral head
- this fixation is particularly on the RC interval
Risk Factors
- Diabetes - #1 (collagen synthesis is disrupted)
- Thyroid Disease
- 40-65 age
- Female > Male
- Stroke- disuse arm
- Prolonged Immobilization
- Previous adhesive capsulitis to other shoulder
4 Distinct Stages
- Inflammation of the shoulder (impinged, syndrome, etc.)
- Painful or “freezing” stage. SIGNIFICANT pain.
- “Frozen” stage. Very little synovitis, but loss of ROM. Pain @ end-range.
- “Thawing” stage. Very little pain, but lots of stiffness.
Stage 1
Inflame of shoulder (impingement syndrome, etc.) w/ painful active loss of ROM, but not passive. May have early mild loss of ER.
Can last 0-3mo.
Stage 2
Painful or “freezing” stage.
Significant pain w/ active & passive loss of ROM
Empty end-feel.
Synovium is red and angry along w/ presence of new pain nerve endings heightening pain
Can last 3-9mo.
Stage 3
“Frozen” Stage
Very little synovitis, but fibrosis w/ loss of motion and impaired function.
Pain @ end-range w/ firm end-feel.
Can last 9-15mo.
Stage 4
“Thawing” stage.
Very little pain, but significant stiffness.
No synovial rxn & gradual return of motion
No tissues are angry anymore.
Can last 15-24mo.
However, patients can recover in stage 3 & not move to stage 4
What is Role of PT
Education, Education, Education!!!
E to the 3rd power!!
Patient education on natural course or progression of the disease.
Key Subjective Findings: In terms of Pain
Stage 2: High irritability, pain 7-10! (new Pain Nerves!) Night or resting pain, lots of functional loss, disability
Stage 3: Moderate irritability, pain 4-6. Intermittent pain based on reaching end-range w/ activity, moderate disability
Stage 4: Low irritability, pain 0-3. Minimal Disability
Key Objective Findings: Goniometer and ROM
Stage 2: Empty end-feel, active ROM less than passive due to pain.
Stage 3: True end-feel (firm?), pain @ end of range w/ end-feel testing, active and passive ROM same. Patient’s shoulder is truly stuck (not just limited by pain or weakness)
Stage 4: Pain w/ overpressure @ end range.
Evaluation:
Diagnosis & Prognosis
Diagnosis: Adhesive Capsulitis: Practice Pattern 4D Connective Tissue
Prognosis: Good resolution from PT and conservative treatment.
Stage 3 adhesive capsulitis has good outcome w/ PT when measuring function parameters. Be careful not to be too aggressive too early- stage 2- (In terms of PT or Surgery).
Intervention: Best combination of treatments?
- Corticosteroid injections (can be given @ any stage) combined w/ shoulder mobility and stretching exercises = more effective in providing short term pain relief & improved function compared to shoulder mobility & stretching alone.
Intervention: in Stage 2 (High Irritability)
- GENTLE, GENTLE, GENTLE
- Educate on position- open pack on pillow while resting
(very comfortable for patient – they will like it) - Codman’s exercises
- GENTLE A/P ROM within pain free range. Activity modifications for function activities in pain-free range.
- Pain grades of mobilization/manipulation
- Pain relieving modalities of heat, US, or Estim (judgement call)
- May not even be seen for PT, or too hot as mvmnt stirs up pain. Consult w/ physician and wait out.
