1. Adhesive Capsulitis Denver Glass, SPT Ryan Griggs, SPT Meredith Wahl, SPT Jessica Wells, SPT Joni White, SPT

2. 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

3. Overview History Anatomy Definition Etiology Prevalence/Incide nce Clinical Exam Tests Imaging Diagnosis Classification Conservative Treatment Manual Therapy Surgical Intervention Prognosis Complications Summary

4. History Adhesive capsulitis reported in medical literature for over 100 years 1872 1932 1934 1945 “Scapulohumeral Periathritis” Resulting from subacromial bursitis “Tenobursite” Resulting from Bicipital Tendinitis “Frozen Shoulder” Resulting from tendinitis of rotator cuff Discovered capsule was tight, thickened, and stuck to humerus Peeled off like “adhesive plaster from skin”

5. Anatomy Axillary pouch Coracoclavicular ligaments Coracoacromial ligament Glenohumeral ligaments Transverse Humeral ligament Coracohumeral ligament

6. 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 glenoid fossa

7. 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

8. 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

9. “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

10. Diagnosis Based on patient history & physical examination Difficult to diagnose clinically Codman’s Criteria - 1934 Lunberg’s Criteria - 1969 Clinical Identifiers - 2009 Arthrography

11. Codman’s Criteria Shoulder pn which comes on slowly & felt at the insertion of the deltoid Inability to sleep on affected sideAtrophy of scapular musclesLocal tenderness

12. Lunberg’s Criteria Painful stiff shoulder for at least 4 wks Severe shoulder pain that interfered with ADLs or work activities Night pain Painful restriction of active and passive elevation to less than 100° & 50% restriction of ER Normal radiological appearanceNo secondary causes

13. 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

14. 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

15. 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

16. 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