July 10th, 2024
Adhesive Capsulitis
What is Adhesive capsulitis (AC), also known as “Frozen Shoulder”?
It is an inflammatory condition leading to shoulder stiffness, pain and significant loss of range of motion (ROM). Adhesive capsulitis can be the main and only disorder, known as a primary diagnosis, or be a result of a specific injury to the shoulder, known as a secondary diagnosis. Research shows adhesive capsulitis begins when the shoulder joint becomes inflamed and leads to build up of adhesions/tissues in the joint and as a result leading to decreased range of motion and pain. Primary AC is from an unknown cause and typically starts slow and gradually worsens. With this form, it is sometimes associated with patients who have other underlying conditions such as diabetes mellitus, thyroid disease, cancer, Parkinson disease, stroke and others. Secondary AC is normally a result of trauma directly to the shoulder such as a rotator cuff tear, a broken bone, or a previous surgery.
There are 3 phases of adhesive capsulitis
The first is the “freezing”, the second is the “frozen” and the last is the “thawing”. The first phase, patients experiencing acute inflammation in the shoulder which can last anywhere from 2-9 months. The next phase is illustrated by an increase in stiffness and limited range of motion in all directions that can last from 4 months to 12 months. The last and final phase is where patients begin to see an improvement of range of motion and overall shoulder mobility, with this phase lasting from 12 to 24 months. There are no specific laboratory test to confirm or deny adhesive capsulitis, although diagnosis can be made based on subjective questioning from medical providers and range of motion deficits.
Management
Since this is a self-limiting condition, patients will report difficulty or limitations with reaching, getting dressed, fastening a seat belt, hanging clothes, brushing/doing their hair and many other activities of daily living (ADLs). Management for AC is depending on the stage of the condition. During the "freezing stage", the focus is inflammation and pain management/reduction. During this phase soft tissue mobilization and gentle stretching can be used for pain modulation as well as modalities such as ultrasound, cryotherapy/thermotherapy and TENs units, During the “frozen stage”, continuing with pain management with modalities such as ultrasound, cryotherapy/thermotherapy and TENs units, and increasing range of motion in the shoulder by adding advanced stretching exercises and incorporating light strengthening with static holds. During the “thawing stages”, increasing range is the priority. This can be achieved by progressive stretching and resistant strengthening exercises as tolerated.
1. St Angelo JM, Taqi M, Fabiano SE. Adhesive Capsulitis. [Updated 2023 Aug 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532955/
2. Chan, H. B. Y., Pua, P. Y., & How, C. H. (2017). Physical therapy in the management of frozen shoulder. Singapore medical journal, 58(12), 685–689. https://doi.org/10.11622/smedj.2017107
3. Mezian K, Coffey R, Chang KV. Frozen Shoulder. [Updated 2023 Aug 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482162/
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