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A 36-year-old female self-referred to an outpatient physical therapy clinic with a 2-month history of right (dominant) shoulder pain. She reports first experiencing pain while fastening her bra. The patient denies any trauma; this is the first time she has sought care for a shoulder injury. Pain intensity has increased since onset and regularly affects her ability to sleep on her right side. In addition to pain, she reports an inability to clean her house, reach overhead, or reach behind her back. The patient's presenting signs and symptoms are consistent with primary adhesive capsulitis of the right shoulder.

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Based on the patient's suspected diagnosis, what do you anticipate may be the contributing factors to her condition?

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What symptoms are associated with this diagnosis?

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What are the most appropriate examination tests?

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AXILLARY FOLD: Region of the armpit consisting of a portion of the pectoralis major muscle forming the anterior border and portions of the latissimus dorsi and teres major muscles forming the posterior border

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IDIOPATHIC: An unknown cause

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PRIMARY ADHESIVE CAPSULITIS: Musculoskeletal condition of the shoulder of unknown etiology marked by significant restriction in shoulder active and passive range of motion1,2

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ROTATOR INTERVAL: Triangular region of the anterior shoulder that contains the coracoid process, supraspinatus and subscapularis tendons, long head of the biceps tendon, and the superior glenohumeral and coracohumeral ligaments

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  1. Describe the differences between primary (idiopathic) and secondary adhesive capsulitis.

  2. Describe the pathophysiology associated with primary adhesive capsulitis.

  3. Describe symptoms associated with adhesive capsulitis.

  4. Describe appropriate clinical examination tests that help rule in primary adhesive capsulitis.

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PT considerations during examination of the individual with suspected primary adhesive capsulitis:

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  • General physical therapy plan of care/goals: Decrease pain; increase muscular flexibility; increase or prevent loss of shoulder range of motion; increase upper quadrant strength; prevent or minimize loss of aerobic fitness capacity
  • Physical therapy tests and measures: Observation of the upper quadrant, active and passive range of motion testing, passive accessory joint motion testing, coracoid pain test, palpation
  • Differential diagnoses: Rotator cuff strain, rotator cuff tendinosis, subacromial impingement, osteoarthritis, tumor, fracture

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Adhesive capsulitis (also known as frozen shoulder) affects up to 5% of the general population and upward of 30% of those with diabetes.2,3 Adhesive capsulitis (AC) primarily affects women between the ages of 40 and 60.4 It is considered a self-limiting condition with some patients experiencing a gradual resolution of symptoms without treatment.

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There are two types of AC: primary (idiopathic) and secondary. Patients experiencing pain and stiffness with no history of trauma or surgery are diagnosed with primary AC. Those with shoulder stiffness due to a history of trauma or surgery in the shoulder region are diagnosed with secondary AC. It is currently ...

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