Lecture 2 - Adhesive Capsulitis

insidious onset of shoulder pain
suddenly increased intensity of shoulder pain with current shoulder condition

Metabolic Syndrome
Diabetes
Thyroid Conditions
Female
45-60
Previous Adhesive Capsulitis in the other arm

1-3 months
sharp pain at End ROM
achy pain at rest
night pain
early loss of ER with INTACT RTC

3-9 months
freezing
progressive loss of ROM in all directions greatest in ER (50% loss)
pain at end
resting pain reducing

9-15 months
frozen
loss of motion with adhesions in inferior capsule
range pain less

15-24 months
thawing
stiffness begins to lessen
pain resolved

P/A
Rule out cervical spine
Assess Mobility (ROM and Joint play)
Assess motor performance

rule out cervical spine
examine for nociplastic pain and/or altered response
determine knowledge of pain/pain beliefs
may refer back to PCP or behavior medicine for subsequent exam and intervention

movement observation - cardinal plane
P/A - probably extra articular so compress first, then bring out of pain and distract
ROM (GH) - ER, then Abduction, then flextion and IR, then extension
Joint Play - traction, inferior glide (scarring and stiffness), posterior glide, anterior glide (most provocative bc it stretches the anterior capsule)
Muscle Performance

Highly irritable - inconlusive
so rule out Cervical spine, spurling's test, and neurological exam

Low/Moderate irritability - Extra articular

passive restrictions with painful end feel (Stage II, III, IV)
ER loss greater than 50% of uninvolved side (0-70 Normal) Stage III
- progressive loss of ER as arm in abducted
Capsular pattern of loss - ER loss greatest followed by abduction, flexion, IR and Ext

Stage I-II - muscle guarding limiting true JP assessment
pain higher in stage III than stage IV

ST dyskinesis present
difficult to MMT secondary to pain and poor quality of movement but should be able to produce isometric contractions with all RTC and ST muscles
No MMT grades if painful - can give qualitative description of muscle function
HHD if available

pain mediation or reduction in symptom severity, restoration of function, restoration of mobility, restoration of strength

pain education/pain science/expectations
Activity Modifications - simple ADL modifications
Course of disease to enable realistic expectations
gentle exercise for home to keep mobility
Integrate this early and consistently!

Manual Therapy
Stretching Exercises
Neuromuscular re-education

manual therapy guided by irritability
therapeutic exercise optimizing mobility/pain modulation- low load high volume
therapeutic exercise ST control - endurance
therapeutic exercise functional restoration - pt needs and goals

small amplitude separation, produces no movement

small movement taking up the crimp (tissue slack) of the joint

enough force to stretch the tissue at the point of limitation

short duration, small amplitude, high velocity movement performed at the point of limitation

small amplitude movement within tissue slack

large amplitude movements within tissue slack

large amplitude movement from mid ROM to tissue stop

small amplitude movement at the tissue stop

short duration, small amplitude, high velocity movement performed at the point of limitation

Norwegian:
stage II-II (low/moderate) do grade I/II
Stage IV do grade III
Australian:
stage I/II - grade I/II
stage III - grade III/IV

pully assisted and low load

use of sensory integration, pain neuroscience
nociplastic - graded motor imagery, sensory motor integration, laterality training
- tactile discrimination, imagined movements, mirror therapy