Physical therapy treatment of Adhesive Capsulitis (Frozen Shoulder)

Adhesive capsulitis or Frozen shoulder is a common shoulder disorder characterized by a gradual increase of pain and limitation in range of motion of the glenohumeral joint. Adhesive capsulitis occurs with synovial inflammation and capsular fibrosis in the glenohumeral joint, leading to restriction of joint motion and pain.

Capsular pattern of Adhesive Capsulitis

Capsular pattern helps in proper diagnosis of patient’s range of movement involved. Range of motion is restricted in following order :

> External rotation

> Flexion/Abduction 

> Internal rotation

Symptoms of Adhesive Capsulitis

The symptoms typically develop slowly over time, often progressing through stages of increasing severity.

• persistent pain in the shoulder that worsen at night
• gradual onset of stiffness in the shoulder joint, making it difficult to perform daily activities such as reaching overhead, dressing, or combing hair
• limited range of motion
• difficulty sleeping
• muscle weakness surrounding the shoulder
• shoulder instability

Causes of Adhesive Capsulitis

The causes of frozen shoulder are not entirely understood, but several factors may contribute to its development. It is associated with many conditions like Diabetes Mellitus,  Thyroid disease, Adrenal disease, Cardiopulmonary disease, Hyperlipidemia,  Parkinson's disease and Dupuytren's contracture.

These causes can generally be classified into primary and secondary categories:

Zuckerman's Classification System for Frozen Shoulder

It provides a framework for understanding the various underlying causes of the condition by organizing them into distinct subcategories.

Important Points to Consider:

• Frozen shoulder tends to occur more frequently in individuals between the ages of 40 and 60, and it's more common in women than in men.
• Traumatic FS can occur due to fracture, dislocation, and soft tissue injury.
• Nontraumatic causes include osteoarthritis, rotator cuff tendinopathy, and calcific tendinitis.

Diagnostic Test for Adhesive Capsulitis 

• External rotation - Hornblower sign
• Flexion / Abduction - Check range of motion. It is restricted greater than 25%.
• Internal rotation – Hawkins Kennedy test

 

Adhesive Capsulitis Stages

• Freezing Phase (Painful Phase): Duration, 10–36 weeks - focus is on pain management

• Frozen Phase (Adhesive Phase): Duration, 4–12 months -  focus is on increasing ROM, such as mobilization techniques or ROM exercises

• Thawing Phase (Recovery Phase): Duration, 12–42 months - so the focus is to maintain scapular motion which gets compensated due to pain and muscular inhibition

Physiotherapy Treatment of Adhesive Capsulitis

Transcutaneous Electrical Nerve Stimulation (TENS)

It is used to manage pain and reduce muscle tightness or muscle guarding.it can be applied for 15-20 minutes twice a day.

Therapeutic Ultrasound

Pulsed mode ultrasound is used to improve extensibility of fibrous tissue structure.

Short Wave Diathermy

It is method of providing deep heat to affected tissue for the purpose of improved mobility.

Exercise to improve Range of Motion

• Improving external rotation using Thera-band

The patient can perform it while sitting on a chair. The unaffected hand is fixed while the affected hand is moved in outward direction holding the thera-band. Another option is to fix one end of thera-band to some fixed support and moving the affected hand outward.

•  Improving internal rotation using Thera-band

Hold one end of a thera-band behind your back i.e. affected hand and grab the other end with other arm. Place the thera-band in a vertical position and try to pull affected arm upwards with the unaffected arm pulling the thera-band. Do this 10 -20 times a day.

•  Improving Flexion and Abduction by finger wall ladder exercise

Face a wall at a 1-foot distance. Touch the wall at your waist level with fingers of your affected arm and walk the fingers up the wall like a spider crawl to the point you can comfortably raise your arm.

•  Quadman exercise

Stand with your unaffected hand resting on a table. Let your other (affected) arm hang down and try to swing it gently in clockwise and anti-clockwise direction i.e. in a circular motion. Repeat about 5 times. Try this 2-3 times a day.

• Wand exercise

It is repeated about 10 times a day. Try this 2-3 times a day.

Gliding for Adhesive Capsulitis

1. Inferior glenohumeral glides facilitate arthrokinematic motions associated with shoulder abduction. Inferior glides may also be used to treat subacromial impingement.
2. Posterior glenohumeral glides facilitate the arthrokinematic motions of flexion and internal rotation of the shoulder.
3. Anterior glenohumeral glides facilitate the arthrokinematic motions of extension and external rotation of the shoulder.

Distraction of Glenohumeral joint

Distractions of joint in loose pack position will facilitate greater mobility with all movements and potentially reduce pain.