1. Flexibility

2. Adhesive Capsulitis

3. What is it?

4. Adhesive Capsulitis Painful restricted ROM Early loss of ER Normal x-rays Occurs in middle-age –aged females greater than males

6. What is the etiology?

7. Adhesive Capsulitis Usually idiopathic Associated with diabetes mellitus, inflammatory arthritis, trauma, prolong immobilization, thyroid disease, stroke, myocardia infarction, or autoimmune disease May also occur secondary to rotator cuff disease

10. Name the three stages ?

11. Stage one First 1 to 3 months Pain with little motion loss initially

12. Stage 2 Months 3 – 9 with reduce pain but increase loss of motion particularly ER

13. Stage 3 Months 9 to 15 with gradual improvement of loss of ROM

14. Adhesive Capsulitis X-rays normal Arthrogram shows a reduce in capsule volume Pathology thought to be due to inflammation in the rotator cuff greater than global capsule, causing capsule tightening

15. Adhesive Capsulitis Stages one and two use modalities, analgesics and NSAD and glenohumeral joint injections to reduce inflammation and pain Facilitate rehabilitation and shorten the duration of the condition. Avoid aggressive exercise because this will exacerbate the condition

16. Codman’s Exercise

17. Passive relax ROM

18. Spencer’s

22. Adhesive Capsulitis Generally near normal function over a 12 – 14 month period. Patient not improve after 4 to 6 months may benefit from manipulation under anesthesia or arthroscopic lysis of adhesions