EASIEST WAY TO LEARN ABOUT ADHESIVE CAPSULITIS

 DEFINITION

Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by stiffness and pain in your shoulder joint. Signs and symptoms typically begin gradually, worsen over time and then resolve, usually within one to three years.

• A more accurate way to look at this is to refer to true adhesive capsulitis (affecting the joint capsule) as a primary adhesive capsulitis.

                      

• Secondary adhesive capsulitis (or true frozen shoulder) might have some joint capsule changes but the shoulder stiffness is really coming from something outside the joint. Some of the conditions associated with secondary adhesive capsulitis include rotator cuff tears, biceps tendinitis, and arthritis.

Adhesive capsulitis

There are some clinical signs that help without doing an arthroscopic exam. For example, in the early stages of adhesive capsulitis, pain is accompanied by stiffness and loss of full passive shoulder motion. External rotation is affected first. The rotator cuff remains strong. These two symptoms differ from secondary adhesive capsulitis (what might otherwise be called a frozen shoulder). The condition referred to as a frozen shoulder is more often characterized by damage to the rotator cuff and loss of internal rotation first. Frozen shoulder typically develops slowly, and in three stages. Each stage can last a number of months.

SYMPTOMS

• Freezing stage. Any movement of your shoulder causes pain, and your shoulder's range of motion starts to become limited.

• Frozen stage. Pain may begin to diminish during this stage. However, your shoulder becomes stiffer, and using it becomes more difficult.

• Thawing stage. The range of motion in your shoulder begins to improve.

For some people, the pain worsens at night, sometimes disrupting sleep.

 ROLE OF PHYSIOTHERAPY

Clinicians may utilize Shortwave diathermy, Ultrasound, or Electrical stimulation combined with mobility and stretching exercises to reduce pain and improve shoulder ROM in patients with adhesive capsulitis

THERMOTHERAPY: Before resorting to passive mobilization, the thick and contracted capsule must be released and made stretchable by deep heating using ultrasonic or other suitable modalities.

The heating is carried out throughout the joint.

• Passive physiological exercise: motion in a range that usually is achieved actively
• Accessory exercise: motion between joint surfaces,which cannot be achieved actively.
 

PHASE 1 PHYSIOTHERAPY

• Used when the patient has a painful joint
• A physical therapist would apply accessory movement in a comfortable joint position, with the affected arm supported in a loose-packed position.
• The therapist administers slow,gentle oscillatory movements in anterior-posterior and cephalad-caudad directions if they do not increase pain or induce muscle spasm.

       PHASE 2 PHYSIOTHERAPY

• Used to treat a stiff joint
• As the condition progresses, the therapist may detect stiffness before or concurrently with the onset of pain.
• The therapist then should begin low-amplitude physiological and accessory oscillations at the limit of the restriction
• To increase abduction, for example, the therapist with caudal glide performs more powerful oscillations at the end of the accessory range.

PATIENT ROLE

• " Patient heal by yourself "
• Pendulum exercises: In a forward stooping position, with one hand resting on a table or chair, the patient gradually swings the arm like pendulum and later carries out a circumduction movement.
• 5 times daily in 5 to 10 minute sessions
  

• SHOULDER ELEVATION EXERCISES: With the normal hand supporting the affected one, the shoulder is gradually lifted to a position of flexion abduction and external rotation.

• HAND TO BACK POSITION: Patient carries the arm backwards with the shoulder in a position of extension, adduction.

  

  SHOULDER ELEVATION EXERCISE AND HAND TO BACK POSITION

  
  

• SHOULDER WHEEL EXERCISES: To be done by the patient himself at the physiotherapy center.
• PULLEY EXERCISES: Which can be done by the patient himself at home
  

* Patient also do these exercises at home

* Frozen shoulder and adhesive capsulitis are actually two separate conditions.

What separates these two diagnoses? Both show up looking like a painful, stiff shoulder. 

 But adhesive capsulitis (as its name implies) affects the fibrous ligaments that surround the shoulder and form what's called the capsule. The condition referred to as a frozen shoulder usually doesn't involve the capsule.