Adhesive Capsulitis CPG

Question 1

Adhesive Capsulitis CPG: Pathoanatomical features

Answer 1

E level: loss of passive motion in multiple planes, esp ER with arm at side and in varrying degrees of abd

Question 2

Adhesive Capsulitis CPG: Risk factors

Answer 2

C level:

• Diabetes mellitus and thyroid disease
• 40-65yo female, prior episode of adhesive capsulitis in opposite arm

Question 3

Adhesive Capsulitis CPG: Clinical Course

Answer 3

B level: stages progression of pain and mobility deficits lasting 12-18mo. Mild to mod mobility deficits may persist past that point, but little to no disability reported.

Question 4

Adhesive Capsulitis CPG: Diagnosis/classification criteria

Answer 4

F level:

-gradual and progressive onset of pain and loss of AROM and PROM in elevation and rotation.

Question 5

Adhesive Capsulitis CPG: Differential Diagnosis

Answer 5

F level:

consider other diagnosis if activity limitations or impairments of body function and structure are not consistent

Question 6

Adhesive Capsulitis CPG: Exam: outcome measures

Answer 6

A level:

• DASH
• ASES
• SPADI

Question 7

Adhesive Capsulitis CPG: Exam: activity limitation and participation restriction measures

Answer 7

F level: use easily reproducible activity limitation and participation restriction measures:

• pain during sleep
• pain and difficulty with grooming and dressing
• pain and difficulty with reaching

Question 8

Adhesive Capsulitis CPG: Physical impairment measures

Answer 8

E level: measure pain, AROM and PROM of shoulder

Question 9

Adhesive Capsulitis CPG: Interventions: corticosteroid injections

Answer 9

A level: intra-articular corticosteroid injections combined with shoulder mobility and stretching exercises are more effective for short term (4-6wk) pain relief and improved function

Question 10

Adhesive Capsulitis CPG: Interventions: patient ed

Answer 10

B level: pt ed that:

1. describes natural course of disease
2. promotes activity modification to encourage functional, pain-free ROM
3. matches the intensity of stretching to pts current level of irritability

Question 11

Adhesive Capsulitis CPG: Interventions: modalities

Answer 11

C level:
can use shortwave diathermy, US, or e-stim combined with mobility and stretching exercises to reduce pain and improve shoulder ROM

Question 12

Adhesive Capsulitis CPG: Interventions: Joint mobilization

Answer 12

C level: can use joint mobs to the GH jt to decrease pain and increase motion and function

Question 13

Adhesive Capsulitis CPG: Interventions: translational manipulation

Answer 13

C level: can use transltaional manip under anesthesia directed to GH jt who are not responding to conservative interventions

Question 14

Adhesive Capsulitis CPG: Interventions: stretching exercises

Answer 14

B level: instruct pts in stretching exercises, intensity determined by tissue irritability level.

Question 15

Primary/Idiopathic adhesive capsulitis

Answer 15

not associated with systemic condition or history of injury.

Question 16

Secondary adhesive capsulitis: extrinsic

Answer 16

Pathology not directly related to shoulder but results in painful and stiff shoulder
Ex: CVA, MI, COPD, liver disease, distal extremity fx

Question 17

Secondary adhesive capsulitis: intrinsic

Answer 17

Known pathology of GH jt soft tissues or structures.

Ex: RTC tendinopathy, biceps tendinopathy, AC or GH jt arthopathy, proximal humeral or scapular fx

Question 18

High irritability features

Answer 18

• high levels of pain >7/10
• consistent night or resting pain
• high levels of reported disability on standardized self report outcome tolls
• pain occurs before end ranges of active or passive movements
• AROM sig less vs PROM due to pain

Question 19

Moderate irritability features

Answer 19

• mod levels of pain, 4-6/10
• intermittent night or resting pain
• mod levels of disability
• pain occurs at end ranges of AROM/PROM
• AROM similar to PROM

Question 20

Low irritability features

Answer 20

• min levels of pain <3/10
• no night or resting pain
• min levels of reported disability
• pain occurs with overpressure into end range of PROM
• AROM same as PROM

Question 21

High irritability interventions

Answer 21

Modalities:
-heat and estim for pain
self care/Pt ed:
-POC, activity mod to limit inflammation and pain
Manual:
-low intensity jt mobs in pain free range
Mobility exercise:
-pain free PROM
-pain free AAROM

Question 22

Moderate irritability interventions

Answer 22

Modalities:
-heat and stim for pain as needed
Self care/pt ed:
-progress activities to gain motion and function without producing tissue inflammation and pain
Manual:
-mod intensity jt mobs into tissue resistance without producing post-tx tissue inflam and pain
Stretching:
-gentle to mod stretching without post-tx inflam and pain
NMR:
-integrate gains in mobility for reaching activities

Question 23

Low irritability interventions

Answer 23

self-care/pt ed:
-performing high demand functional/recreation activities
Manual:
-end range jt mobs, high amplitude and long duration into tissue resistance
Stretching:
-into tissue resistance without producing post tx inflam and pain
NMR:
-integrate mobility gains into normal scapulohumeral mvmt for activities performed by pt for functional/recreational activities