Scenario 12- adhesive capsulitis

Question 1

Diagnosis- Adhesive capsulitis 5/12 ago.
Pa= Deep dull ache 2/10, increases to 6/10 on movement esp. lateral rotation and abduction.
No paraesthesia
No anaesthesia
No pain or symptoms reported elsewhere.

Problem List?

Answer 1

Pain in lateral rotation and abduction 6/10
Deep dull ache 2/10 constant.
5/12 ago.

S- Moderate
I- High
N- Inflammatory

Question 2

adhesive capsulitis pathology

Answer 2

Also known as frozen shoulder

Symptoms- decreased ROM, pain, stiffness.

Condition which affects the glenohumeral joint and synovial capsule.

Characterised by significant restriction of active and passive shoulder movement.

Linked to diabetes, heart disease, shoulder trauma or surgery, inflammatory disease, cervical disease, and hyperthyroidism.

3 Distinctive phases-

- Phase 1- increasing pain accompanied by increasing stiffness. (10-36wks) 
- Phase 2- decreasing pain with stiffness remaining (4-12 months) 
- Phase 3- decreasing stiffness and gradual return to normal (12-42 months) 

Evidence suggests initial inflammatory process leading to fibrosis of capsule.
Rotator cuff interval (Superior GH and coracohumeral ligaments) and anterior capsule most affected.

Results in loss of capsular flexibility and decreased glenohumeral ROM.

Question 3

Capsular Pattern and normal ROM?

Answer 3

Capsular Pattern
-Lateral rotation, abduction, medial rotation.

Normal joint movements

Flexion: 160-180 
Extension: 50-60 
Abduction: 170-180
Medial Rotation: 70-90
Lateral Rotation: 80-100

Question 4

Risks/ special questions?

Answer 4

Diabetes
Hyperthyroidism
Cervical disk disease of neck

Question 5

Assessment

Answer 5

1.) Active vs Passive physiological ROM

Look specifically at capsular pattern (Lateral rotation, Abduction and medial rotation.)
Compare to unaffected arm and goniometer compared to normal joint range movements.
PROM should be restricted.
Hard end feel
In AROM look for quality, control, coordination, and patients perception of what comes first pain or resistance.

2.) Apprehension Tests

Tests glenohumeral joint stability

- Patient supine abduct shoulder to 90°
- Move to maximum lateral rotation 
- positive= patient becomes apprehensive/uneasy. 

Relocation Test

- In same position as apprehension test apply force to head of humerus using heel of hand.
- Positive = apprehension lessened, further ROM in lateral rotation.

Question 6

Treatment

Answer 6

1.) Joint Mobilisations

Non aggressive
Maximise pain free ROM
AP glide - arm abducted 40°
- heel of palm on humeral head
- Apply glide (grade 2 /3 determined by pain or resistance.)
- decrease pain. (stimulates mechanoreceptors and decreases nocioreceptor firing.)
- assist with flexion and internal rotation

PA Glide - assist extension and external rotation

Caudal - Assists Abduction

2.) Passive Stretches

Stretch abductors (Supraspinatus, deltoid)

Stretch Medial rotators (Subscapularis, Teres major, Latissimus Dorsi, Pectoralis major.)

Stretch Lateral rotators (Teres minor, Infraspinatus.)

Stretching will reduce the muscle tension, by increasing connective tissue elasticity. This forms mechanical disruption of muscle cross bridges, and the micro-fracture of collagen fibres (plasticity).
This stimulates Golgi tendons, tension passes a certain length and the muscle relaxes; autogenic inhibition.

Question 7

Exercises

Answer 7

Shoulder flexion/ extension
Shoulder abduction
External/ Internal rotation
Scapular Range of motion