Frozen Shoulder / Adhesive Capsulitis ( Lowe) Flashcards
What is Frozen Shoulder/Adhesive Capsulitis
frozen shoulder: glenohumeral stiffness and lost range of motion resulting from a non-contractile
element in the shoulder that is not necessarily capsular in nature
-refers to a set of symptoms in the shoulder involving pain and limited motion at the GH joint
-refers to a variety of pathologies: adhesive capsulitis, subacromial bursitis, calcific tendinitis, rotator cuff pathology
-describes a functional limitation in range of motion associated with pain and stiffness
adhesive capsulitis: involves loss of active and passive motion due to adhesions within the
glenohumeral joint capsule
-refers to a discrete clinical pathology
-both have the common element of pain and limited motion in the shoulder associated with inert tissues
Characteristics
Characteristics: GH joint has the greatest range of motion of any joint; therefore, a degree of slack or pliability in the joint capsule and surrounding soft tissues is necessary to allow full motion
-if a full range of soft-tissue pliability is not available, limitation in joint ROM occurs and results in stiffness and pain
-the glenohumeral joint capsule is composed of capsular and ligamentous fibres; on the anterior aspect, the superior, middle and inferior glenohumeral ligaments blend with the capsular fibres; on the superior side, stability is enhanced as the coracohumeral ligament blends with the capsular fibres
-when the shoulder is in neutral, the underside of the capsule (axillary recess/pouch) is relaxed
-during certain motions, abduction or lateral rotation, the pouch is stretched and becomes taut
-scapulohumeral rhythm is the ratio of movement that occurs at the scapulothoracic articulation and
GH joint with full abduction
-it is a 2:1 ratio; for every 3° of shoulder abduction, 2 occur at the GH joint and 1 at the ST articulation
-in frozen shoulder GH abduction past about 40° is severely restricted/eliminated; all remaining movement of abduction is at the ST articulation
-in adhesive capsulitis, adhesions form inside the capsule causing the inner walls of the pouch to adhere; the pouch can no longer fully stretch causing pain and limited ROM; abduction and lateral rotation most limited because they stretch the anterior/inferior portions of the capsule
Primary Frozen Shoulder:
Primary Frozen Shoulder: idiopathic; may be an autoimmune disorder; may include shortening of the joint capsule, fibrosity and shortening of the coracohumeral ligament, subscapular bursitis, fibrosity within the rotator interval (portion of the GH joint capsule between the supraspinatus and subscapularis tendons), postural distortion in the shoulder, active MFTs in the shoulder muscles or adhesions between rotator cuff muscles and articular inert tissues (joint capsule and humeral head)
Secondary Frozen Shoulder:
Secondary Frozen Shoulder: results from another pathology; rotator cuff tears, arthritis, bicipital tendinosis/tenosynovitis, surgery, shoulder separation, diabetes, GH subluxation; same tissues are affect as with primary frozen shoulder but there is more capsular adhesion; scar tissue can adhere the axillary folds together; some period of shoulder immobilization precedes the onset of symptoms
-the development of frozen shoulder and its resolution proceeds in stages: pain, stiffness, recovery (stages 1, 2, and 3; freezing, frozen and thawing)
-with both types, there is pain and limited movement (capsular pattern due to joint capsule and ligamentous tissue involvement)
-women more affected; 40-70 years old, may be related to hormonal changes of menopause; other metabolic and systemic factors may also be involved; higher risk with diabetes; can last 18-24 months or longer
History
History: pain during various shoulder motions (abduction, rotation, flexion); symptoms may interfere with ADLs (brushing teeth/hair, dressing); come on gradually, ask about systemic disorders, prior trauma, surgery or injury to the shoulder that immediately preceded symptoms
Observation
Observation: when held in neutral position, no visible signs; motion restrictions during ROM evaluation; extensive muscular compensation evident, alteration to scapulohumeral rhythm evident; demonstrates apprehension with motions (lateral rotation/abduction)
Palpation
Palpation: difficult to palpate due to depth of tissues; hypertonic or tender muscles around shoulder possible
Range of Motion and Resistance Testing
AROM: pain and restricted range in capsular pattern; compensating patterns during abduction; pain
with flexion possible
PROM: as with AROM; end-feel occurs prior to natural end ROM, may be accompanied by severe pain
MRT: not likely to cause further discomfort; may be pain prior to test due to tissue stretch of joint capsule and other affected tissues; weakness possible due to reflex muscular inhibition
Special Tests:
Apley Scratch: standing; bring one arm as far as possible into abduction and lateral rotation; other arm into adduction and medial rotation; observe position of hands and compare bilaterally
-evaluates ROM limitations (not specifically assessing frozen shoulder)
-restriction involves adductors, medial rotators or GH joint capsule because limit abduction and lateral rotation
Differential Evaluation:
subacromial bursitis, shoulder impingement, rotator cuff tears or tendinosis, calcific tendinitis, cervical neuropathy, brachial plexus compression, arthritis, subscapular bursitis, bicipital tendinosis/tenosynovitis, myofascial trigger point pain, thoracic outlet syndrome
Suggestions for Treatment:
affected tissues need to be lengthened and mobility enhanced; ultrasound, massage to heat the deep capsular tissues to make them more pliable; gliding, stripping and static compressions to decrease hypertonicity in muscles around GH joint; stretching and movement encouraged in the direction of motion restriction; slowly, gradually; hold stretch just short of pain or restriction barrier; repeat ROM regularly; surgery or joint manipulation under anesthesia may be performed
