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151: ADHESIVE CAPSULITIS (FROZEN SHOULDER)

Matthew Daugherty, DPT, MOT, OCS, FAAOMPT

CONDITION/DISORDER SYNONYM

  • Frozen shoulder syndrome

ICD-9-CM CODE1

  • 726.0 Adhesive capsulitis of shoulder

ICD-10-CM CODE2

  • M75.00 Adhesive capsulitis of unspecified shoulder

PREFERRED PRACTICE PATTERN3

  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and ROM Associated with Localized Inflammation

PATIENT PRESENTATION

A 48-year-old woman, whom is employed as an insurance agent, comes to your outpatient physical therapy clinic self-referred with a 3-month history of right shoulder pain. She first noticed general pain around her glenohumeral joint when putting on her seat belt and fastening her bra. She denies any mechanism of injury and feels that the symptoms are gradually worsening. In addition to the pain, she reports an inability to reach overhead or behind her back and is unable to sleep on her right side.

Her right shoulder passive range of motion (PROM) is limited to 115 degrees of flexion, 100 degrees of abduction, 35 degrees of extension, 30 degrees of external rotation, and 50 degrees of internal rotation. Her left shoulder PROM is 175 degrees of flexion, 175 degrees of abduction, 40 degrees of extension, 90 degrees of external rotation, and 70 degrees of internal rotation. When testing her right glenohumeral joint mobility you determine global hypomobility with a very firm end feel and local discomfort reported during motion testing. She has palpable tenderness at the coracoid process, intertubercular groove, and the greater tuberosity of the humerus. Functionally she has difficulty finding a position of comfort.

KEY FEATURES

Description

  • Self-limiting shoulder pain and dysfunction due to:

    • Localized inflammation of the glenohumeral joint capsule

    • Paucity of synovial fluid

    • Fibrosis of the capsule causing adherence to the humeral head

  • Three pathologic pathways

    • Primary (idiopathic)

    • Secondary: Can be attributed to a known intrinsic, extrinsic, or systemic cause

    • Tertiary: Postoperative or post-fracture

  • Adhesive capsulitis can be divided into four stages

    • Stage 1: “Preadhesive”

      • Near normal range of motion (ROM), pain at end points of motion and mild synovitis

    • Stage 2: “Freezing”

      • Marked loss of motion, pain at end points with thickened read synovitis

    • Stage 3: “Frozen”

      • Marked loss of motion, painless ROM with capsule fibrosis and adhesions

    • Stage 4: “Thawing”

      • Improved glenohumeral motion, painless ROM; no synovitis present

FIGURE 151-1

Anatomy of the shoulder joint. The anterior window in the joint capsule exposes the inner attachment of the biceps brachii muscle. (From LeBlond RF, DeGowin RL, Brown DD. DeGowin’s Diagnostic Examination. 9th ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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FIGURE 151-2

Motions at the shoulder. There has been much confusion in terminology about shoulder motion. The system presented here leaves no room for misinterpretation. Elevation is a movement of the arm along any ...

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