Adhessive Capsulitis

ADHESSIVE CAPSULITIS
“Shoulder pain and mobility deficits: Adhesive capsulitis” Clinical practice guidelines
Adhesive capsulitis is generally characterized as loss of ER, abduction and internal rotation, or the GH capsular pattern.  It is reported in 2.5-5% of the population and more prominent in women than men.  Specifically, females between the ages of 40-65 years of age are more susceptible.   Other risk factors include but are not limited to individuals with diabetes and or thyroid disease.  It is noted through various cadaver studies that angiogenesis/neurogenesis may begin in the capsular ligamentous complex resulting in heightened pain sensation.  Cadaver studies also reveal fibrotic and contracted tissues in the capsuloligamentous structures resulted in ROM deficits and stiffness.
Clinical presentation:
Patient will have loss of passive rom in multiple planes, specific to ER, abduction.  Pain will initially present gradually and slowly progress as ROM limitations increase.
4 stages of progression

Stage 1:
-Up to 3 months
-Sharp pain at EROM, sleep disturbance, ache at rest
-ER ROM loss begins
-Associated subacromial impingement
Stage 2: “painful or freezing stage”
-3-9 months
-Continual loss of motion in all directions
-Aggressive synovitis noted
Stage 3: “frozen Stage”
-9-15 months
-Pain
-motion remains loss
Stage 4: “thawing Stage”
--15-24 months
 -ROM begins to improve
-Stiffness still remains
Pain classification guidelines can be noted with the link here.  I suggest you review the pain classification guidelines.  As a quick review the guidelines using strict criteria place shoulder pain into 3 separate categories:
-Mobility deficits/Adhesive capsulitis
-Shoulder instability/motor control
-Rotator cuff syndrome
Once classified, the patient is further evaluated and examined for tissue irritability level:
-High irritability7-10/10 VAS, high disability, constant night pain, Pain before EROM
-Moderate irritability4-6/10 VAS, moderate disability, intermittent night pain, Pain at EROM
-Low irritability0-3/10 VAS, low disability, minimal night pain, Pain with overpressure
Interventions based upon Irritability levels
High Irritability:
Modalities
-heat/ice/IFC
Manual therapy
 -Low Intensity Joint mobs
Mobility exercises
 -Pain free PROM
 -Pain free AROM
Moderate Irritability:
Modalities
-heat/ice/IFC
Manual therapy
 -Moderate Intensity Joint mobs
Mobility exercises
 -Gentle to moderate PROM
 -Gentle to moderate AROM
Neuro re-ed
 -Promote scapulohumeral movements
Low Irritability:
Manual therapy
 -EROM Joint mobs
Mobility exercises
 -EROM PROM
 -EROMAROM
Neuro re-ed
 -Promote scapulohumeral movements

Injections:
Corticosteroid injections have been proven to be more affective in conjunction with therapeutic interventions, then with therapeutics interventions alone.