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Adhesive Capsulitis. Denver Glass, SPT Ryan Griggs, SPT Meredith Wahl, SPT Jessica Wells, SPT Joni White, SPT. Search History. Databases: CINHAL, MedLine , Google Scholar, Springer, Sage Publications Search Terms:

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adhesive capsulitis

Adhesive Capsulitis

Denver Glass, SPT

Ryan Griggs, SPT

Meredith Wahl, SPT

Jessica Wells, SPT

Joni White, SPT

search history
Search History
  • Databases:
    • CINHAL, MedLine, Google Scholar, Springer, Sage Publications
  • Search Terms:
    • Adhesive Capsulitis, Frozen Shoulder, Rehabilitation, Conservative Treatment, Manual Therapy
  • Dates Searched:
    • 8/28/09 – 9/1/09
overview
Overview
  • History
  • Anatomy
  • Definition
  • Etiology
  • Prevalence/Incidence
  • Clinical Exam
  • Tests
  • Imaging
  • Diagnosis
  • Classification
  • Conservative Treatment
  • Manual Therapy
  • Surgical Intervention
  • Prognosis
  • Complications
  • Summary
history
History
  • Adhesive capsulitis reported in medical literature for over 100 years
  • Discovered capsule was tight, thickened, and stuck to humerus
  • Peeled off like “adhesive plaster from skin”
  • “Tenobursite”
  • Resulting from Bicipital Tendinitis

1932

1945

1872

1934

  • “ScapulohumeralPeriathritis”
  • Resulting from subacromial bursitis
  • “Frozen Shoulder”
  • Resulting from tendinitis of rotator cuff
anatomy
Anatomy

Coracoclavicular ligaments

Coracoacromial ligament

Transverse Humeral ligament

Coracohumeral ligament

Glenohumeral ligaments

Axillary pouch

definition
Definition
  • “Spontaneous onset of gradually progressive shoulder pain and severe limitation of movement”
  • Inflammation of joint capsule/synovium results in capsular contractures
  • Contracted capsule holds the humeral head tight against the glenoidfossa
etiology
Etiology
  • Still unknown – Idiopathic
  • Possibilities:
    • Unknown stimulus produces profound histological changes in the capsule
    • Trauma, autoimmune disorders, cervical dysfunction, tendinitis, bursitis, and hormonal changes
    • Rotator cuff tendinitis
  • Insidious onset
  • Lack of use of arm due to fear of increasing pain
prevalence incidence
Prevalence/Incidence
  • 2-5% in normal population
    • Up to 20% in diabetics
  • Females
  • Age > 40 y/o
  • Contralateral involvement 20-50%
  • Recurrence in ipsilateral shoulder – Rare
  • Some studies report:
    • Self-limiting 1-3 years
    • 20-50% suffer long term ROM deficits up to 10 yrs
typical patient
“Typical Patient”
  • Female
  • 50-70 y/o
  • No hand preference
  • Rarely occurs simultaneously bilaterally
  • Commonly associated with other systemic and nonsystemic conditions
    • Dupuytren’s disease, thyroid disease, Parkinson’s disease, Osteoporosis, Cardiorespiratory conditions, hyperlipidemia, diabetes**, etc
diagnosis
Diagnosis
  • Based on patient history & physical examination
  • Difficult to diagnose clinically
  • Codman’s Criteria - 1934
  • Lunberg’s Criteria - 1969
  • Clinical Identifiers - 2009
  • Arthrography
clinical identifiers
Clinical Identifiers
  • Strong component of night pain
  • Marked  in pain with rapid or unguarded movements
  • Uncomfortable to lie on affected shoulder
  • Pain easily aggravated by movement
  • Onset generally in those >35 y/o
  • Global loss of AROM & PROM
  • Pain at the end of range in all directions
  • Global loss of passive GH joint movement
physical examination
Physical Examination
  • Arm held against body with shoulder ADD & IR
  • Disuse atrophy: RTC, deltoids, biceps, triceps
  • TTP: long head of biceps
  • Loss of AROM & PROM 2° pain & guarding  empty end-feel
  • Compensate for GH movement with scapular movement
  • Resisted movements at midrange may not cause pain capsular
  • ER > ABD > IR
coracoid pain test
Coracoid Pain Test
  • Digital pressure on the area of the coracoid process
  • Positive Test: 3/10 VAS
  • Positive in 96.4% of patients with adhesive capsulitis
  • Highly SpIN & SnOUT
  • Easy & reliable way to identify patients with or without the condition
arthrography
Arthrography
  • Joint volume <10 ml (at least 50% )
  • Box-like appearance of joint cavity
  • Tight, thickened capsule
  • Marked loss of normal axillary fold
  • Absence of dye in biceps tendon sheath