Adhesive Capsulitis CAT

Question 1

What is adhesive capsulitis?

Answer 1

• AKA frozen shoulder
• Inflammation and fibrotic thickening of the anterior joint capsule of the shoulder

Question 2

What happens with adhesive capsulitis?

Answer 2

• Inflamed capsule becomes adherent to the humeral head
• GH joint undergoes contracture

Question 3

Classification of adhesive capsulitis

Answer 3

• Primary
• Secondary

Question 4

Primary adhesive capsulitis

Answer 4

• Occurs spontaneously, unknown etiology
• Associated with DM, thyroid abnormalities, and cardiopulmonary conditions

Question 5

Secondary adhesive capsulitis

Answer 5

• Results from underlying conditions
• Can result from trauma, immobilization, CRPS, RA, abdominal disorders, psychogenic disorders, or orthopedic intrinsic disorders

Question 6

Which demographics are more impacted by adhesive capsulitis?

Answer 6

• Middle-age
• Females > males

Question 7

Clinical presentation of adhesive capsulitis

Answer 7

• Restricted AROM and PROM
• Acute phase- pain radiating below the elbow, may wake up patient at night, PROM limited due to pain and guarding
• Chronic phase- pain localized to lateral brachial region, no woken by pain, PROM restricted due to capsular stiffness

Question 8

Capsular pattern for AC

Answer 8

ER –> abduction –> IR

Question 9

What role does imaging play with adhesive capsulitis?

Answer 9

• Arthrogram may detect decreased volume of fluid in the capsule
• Other imaging is for differential diagnosis

Question 10

Normal volume of GH joint for synovial fluid

Answer 10

16-20 mL

Question 11

Volume of GH joint for synovial fluid w/ adhesive capsulitis

Answer 11

5-10 mL

Question 12

Other likely observations with adhesive capsulitis

Answer 12

• Muscle spasms due to guarding
• Loss of reciprocal arm swing
• Disuse muscle atrophy

Question 13

Management of adhesive capsulitis

Answer 13

• Usually a self-limiting process that takes 12-24 months to recover from
• Use medications to manage pain
• Corticosteroids may restore some ROM
• Surgery as a last resort

Question 14

Physical therapy treatment of adhesive capsulitis

Answer 14

Acute phase
- Ice/superficial heat
- Gentle joint mobs
- Strengthening
- Pendulums
- Isometric strengthening
Chronic phase
- Ultrasound
- Grade III/IV mobs
- PNF

Question 15

HEP for adhesive capsulitis

Answer 15

Acute phase
- Self-stretching (avoid abduction to protect subacromial tissue)
Chronic phase
- Self-stretching
- Progressive exercise
- Posture management
- PNF
- Pendulums
- “Wall climbs”

Question 16

Long-term outcomes w/ adhesive capsulitis

Answer 16

• Most fully recover
• Small percentage have some permanent loss of ROM
• Usually they’re asymptomatic and have unimpaired function

Question 17

How to differentiate adhesive capsulitis from bursitis

Answer 17

• Abduction >60 degrees
• Flexion >90 degrees
• Lasts only a few days, or will resolve itself in a few weeks