Adhesive Capsulitis : How do we treat

Frozen shoulder, also known as adhesive capsulitis, is defined as “a condition of uncertain aetiology, characterised by significant restriction of both active and passive shoulder motion that occurs in the absence of a known intrinsic shoulder disorder”Adhesive capsulitis of the shoulder is a condition of unknown etiology that results in the development of restriction of active and passive gleno humeral motion.

Symptoms

• Patient typically experience insidious shoulder stiffness,
• severe pain that usually worsens at night, and
• near-complete loss of passive and active external rotation of the shoulder.

There are typically no significant findings in the patient’s history, clinical examination or radiographic evaluation to explain the loss of motion or pain.

The insidious onset of pain causes the individual to gradually limit the use of the arm. Inflammation and pain can cause reflex inhibition of the shoulder muscles, similar to inhibition of the quadriceps after injury to the knee. Disuse of the arm results in loss of shoulder mobility whereas continued use of the arm through pain can result in development of subacromial impingement. Subsequently, the individual gradually begins to lose motion and finds it increasingly difficult to perform activities of daily living that require overhead movement of the involved arm, reaching out to the side, or rotation of the humerus. Pain and muscular inhibition result in compensatory movements of the shoulder girdle to minimize pain. With time, there is resolution of pain and the individual is left with a stiff shoulder with severe limitation of function activity.

Stage of Adhesive capsulitis

Examination

• The physical examination always should include
• an evaluation of the cervical spine and the shoulder.
• Stage 1 & 2  presenting  pain on palpation of the anterior and posterior capsules and describe pain radiating to the deltoid insertion.
• Night pain and pain at rest are common.
• Evaluation of active and passive ROM.
• ROM assessment (supine as well as in standing)

Measurements are made in the coronal plane as opposed to the scapular plane, because the anterior capsule is more lax in the scapular plane and gives the appearance of better range ROM. With the patient in the supine position, passive internal and external rotation at 45° glenohumeral abduction and maximal glenohumeral abduction are measured and recorded.

Treatment:

Shoulder joint is made for open chain activity but we should start exercise in Close chain.

Here we keep a link of an exercise that give us a best result in our clinical practice. First concentrate of posterior capsule release. It is difficulty to gain rotation in initial stage. Here we wrote our clinical experience exs whihc gives us excellent result. [restrict] Do not concentrate on rotation first. The Arthroscopic capsular release patient come at your doorstep than start release the muscles. Manipulation grade 1 help to give a mobilise the capsule. Already, surgeon remove all the adhesion so Grade 2-3 mobilization doesn’t help you at all. Below we mentioned a non operatiove treatment of Adhesive capsulitis.

It is important to understand to begin rehabilitation exs,shoulder flexion perfome in supine only, ( without moving scapula) before allowing the patient to move the arm into higher flexion. This procedure allows the scapular muscles to gain strength.

• Improve the saggital movement first : Flexion than followed by Lateral rotation.
• Release subscapularis, Lattismus dorsi
• Supine Shoulder flexion till you find good GH joint motion without any compensation.

• Scapula setting
• Prone pendulum exs
• Strengthening exs should start after 90-100 degree of GHJ disassociation and good control of joint motion.(start serratus Dynamic Hug exs, Lower trap)

References:

1) Hannafin, Jo A.et al. Adhesive Capsulitis Atreatment approach

2) Ayub E: Posture and the Upper Quarter. In Donatella RA (ed). Physical Therapy of the Shoulder. Ed 2. New York, Churchill Livingstone 81-90, 1991.

3) Alman BA, Greel DA, Ruby LK, Goldberg MJ, Wolfe HJ: Regulation of growth and platelet-derived growth factor expression in palmar fibromatosis (Dupuytren’s disease) by mechanical strain. Transactions of the Second Combined Meeting of the Orthopaedic Research Societies of the United States, Japan, Canada and Europe 108, San Diego, CA, 1995.

4) Harryman III DT, Sidles JA, Clark JM: Translation of the humeral head on the glenoid with passive glenohumeral motion. J Bone Joint Surg 72A:1334-1343, 1990. [/restrict]

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