Adhesive Capsulitis and Treatment

The patient's history, symptoms, and examination findings are consistent with a diagnosis of primary adhesive capsulitis. Her right shoulder passive range of motion (PROM) is limited to 100° of flexion, 40° of extension, 85° of abduction, 10° of external rotation (ER), and 50° of internal rotation (IR). The PROM of her left (uninvolved) shoulder presents with: flexion 170°, extension 40°, abduction 170°, ER 90°, and IR 70°. Palpation of the right shoulder reveals tenderness at the greater tubercle (rotator cuff insertion site), intertubercular groove, and the coracoid (positive coracoid pain test).

Describe a physical therapy plan of care based on each stage of the health condition.

Based on the patient's diagnosis, what are appropriate physical therapy interventions?

ARTHOGRAPHY: Injection of a contrast medium (e.g., Hexabrix and 2% Xylocaine; 1:1 ratio) into a joint (i.e., glenohumeral) performed during fluoroscopy; shoulder arthrogram is performed to assess joint capacity; results may aid in the diagnosis of adhesive capsulitis.

CONSTANT SCORE: Valid and reliable outcome measure for patients with shoulder pathology

KALTENBORN MOBILIZATION GRADING SCALE: I to III graded mobilization scale; grade I technique is a traction mobilization performed to decrease pain. Grade II is a glide or traction mobilization performed to increase joint play and decrease pain. Grade III is performed to increase joint play at end range.1

MAITLAND MOBILIZATION GRADING SCALE: I to V graded mobilization scale; oscillatory mobilizations are performed with grades I to IV; a high-velocity low-amplitude thrust is performed with grade V; purpose of grades I and II mobilizations is to decrease pain, whereas purpose of grades III to V mobilizations is to increase joint mobility.2

MOBILIZATION: Skilled, passive movement of a synovial joint performed by a therapist for the purpose of decreasing pain and/or improving joint range of motion

MULLIGAN MOBILIZATIONS WITH MOVEMENT: Joint mobilization technique that consists of active movement performed by the patient when a mobilization force is provided by the physical therapist

PRIMARY ADHESIVE CAPSULITIS (AC): Musculoskeletal shoulder condition of unknown etiology marked by significant restriction in active and passive range of motion

1. Describe appropriate physical therapy interventions for patients with primary AC.

2. Compare outcomes between treatment approaches reported in the literature.

3. Describe treatments that may be prescribed or performed by orthopaedic physicians.

PT considerations during treatment of the individual with a diagnosis of primary adhesive capsulitis:

• General physical therapy plan of care/goals: Decrease pain; increase muscular flexibility, range of motion, accessory joint movement, and upper quadrant strength; prevent or minimize loss of aerobic fitness capacity
• Physical therapy interventions: Patient education regarding functional anatomy and injury pathomechanics; modalities and manual therapy to decrease pain; muscular flexibility exercises; self-mobilization exercises to increase range of motion; resistance exercises to increase muscular endurance of the ...