PT Pathologies: Adhesive Capsulitis

Adhesive capsulitis, also known as frozen shoulder occurs in individuals when the connective tissue surrounding the shoulder joint, known as the shoulder capsule, becomes thickened and tight.  Stiff bands of tissue called adhesions develop.  As these adhesions form, they cause pain stiffness, and loss of motion in the shoulder.  There are two types of adhesive capsulitis, primary and secondary.  Primary AC occurs spontaneously, while secondary is the result of an underlying condition.  This pathology tends to be a more common occurrence in individuals with diabetes, thyroid issues, Parkinson's disease and heart disease.  The typical age range for individuals to experience frozen shoulder is 40-60 years and is more commonly seen in women.

Adhesive capsulitis occurs gradually and in three stages, also known as the freezing stage, frozen stage, and thawing stage.  The freezing stage can last anywhere from 6 weeks to 9 months.  This stage is characterized by a continual increase in shoulder pain and a decreased range of motion.  In particular, the patient has trouble with shoulder abduction and external rotation.  During the frozen shoulder stage patients can actually experience less pain due to even less ROM and can last from 4-6 months.  The final thawing stage, is characterized by slow improvement in shoulder range of motion.  Recovery or return to normal strength can take anywhere from 6 months to 2 years.

Physical therapy is the most common treatment for frozen shoulder.  Once the stage is identified the PT will set up a plan of care tailored to the patient.  If the patient is in the "freezing stage" the PT will assist in maintaining ROM and reducing pain.  when in the first stage, it is normal for the PT to utilize a combination of stretching and manual therapy techniques to increase ROM.  Ice and heat can be used during this time to help relax the muscles before treatment.  An individualized HEP is normally given to the patient to reduce loss of ROM.  During the frozen stage PTs will be concentrating on gaining back the lost ROM.  In this stage the PT will use more aggressive stretching techniques and manual therapy.

In Summary:

• Occurs more in the middle aged population with females having a greater incidence than males
• Arthrogram can assist with diagnosis by detecting decreased volume of fluid within the joint capsule
• Range of motion restriction typically in a capsular patter (External rotation > abduction > internal rotation)