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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. Databases: CINHAL, MedLine , Google Scholar, Springer, Sage Publications Search Terms:

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Adhesive Capsulitis

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  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/Incidence • 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 • 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

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

  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 glenoidfossa

  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

  12. Lunberg’s Criteria

  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

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