Adhesive Capsulitis (Frozen Shoulder)

Shoulder Pain with Mobility Deficits

  • The exact cause of adhesive capsulitis is not completely understood; however, it has been divided into primary and secondary categories; primary being idiopathic and secondary being related to systemic, extrinsic or intrinsic pathology. If your patient has a history of diabetes mellitus, thyroid dysfunction, or a history of contralateral frozen shoulder along with symptoms similar to 1 of the 4 clinical stages they may be suffering from adhesive capsulitis!

  • If you do not know the common clinical findings no problem! Click here


Anatomy

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Image via Complete Anatomy 2018 by 3D4 Medical


Key Finding

Aside from clinical findings in the subjective exam, patients with adhesive capsulitis will also present with impaired glenohumeral joint range of motion actively and passively (depending on the stage). This restriction typically follows the capsular pattern of the glenohumeral joint: external rotation, abduction, and internal rotation going from most restricted to least restricted. Flexion also tends to be limited and is often accompanied by compensatory shoulder girdle elevation. (Click image to watch 1-2 minute video)

Treatment

Treatment depends on stage and irritability of the patient. If the patient has low to moderate irritability and demonstrates capsular restriction, research shows that posterior and inferior glides may be beneficial toward improving pain and range of motion in these individuals! (Click image to watch 1-2 minute video)

Therapeutic Exercise

Research demonstrates moderate evidence to support the use of stretching exercises in individuals with adhesive capsulitis. Exercises should be matched to patient tolerance; if open chain proves to be too difficult, light closed chain range of motion exercises may be a better choice! (Click image to watch 1-2 minute video)

*Clinical Side Note: When working with individuals with adhesive capsulitis it is important to remember that the process could last 12-18 months with symptoms potentially being present longer. Education on the process and managing patient expectations is an integral part of the rehabilitation process. Depending on the stage of adhesive capsulitis, as well as clinical judgement, it may be beneficial to postpone use of patient visits until progress can be made!