Adhesive Capsulitis

Presentation is about Adhesive Capsulitis also called Frozen Shoulder

1. 3/29/2021 Frozen Shoulder by Dr. Shazia Khalfe 1

2. Adhesive Capsulitis By Dr. Shazia Abdul Hamid Khalfe , PT

3. Objectives At the end of webinar students will be able to: Define Adhesive Capsulitis. Explain the types of Adhesive Capsulitis. Epidemiology of Adhesive Capsulitis. Identify the Clinical Presentation of Adhesive Capsulitis. Assess Adhesive Capsulitis. Identify different Physiotherapeutic Options for Treatment of Adhesive Capsulitis. Plan the Physical Therapy Treatment for Adhesive Capsulitis. Exercises for Adhesive Capsulitis. 3/29/2021 Frozen Shoulder by Dr. Shazia Khalfe 3

4. Shoulder Joint 3/29/2021 Frozen Shoulder by Dr. Shazia Khalfe 4

5. Shoulder Joint 3/29/2021 Frozen Shoulder by Dr. Shazia Khalfe 5

6. Shoulder Joint 3/29/2021 Frozen Shoulder by Dr. Shazia Khalfe 6

7. Capsular pattern of Shoulder The  shoulder  joint has a  capsular pattern  where external rotation is more limited than abduction which is more limited than internal rotation (ER limitations > ABD limitations > IR limitations ). [https://www.physio-pedia.com] 3/29/2021 Frozen Shoulder by Dr. Shazia Khalfe 7

8. What is Adhesive Capsulitis? 3/29/2021 Frozen Shoulder by Dr. Shazia Khalfe 8

9. Adhesive Capsulitis The first recorded description of a frozen shoulder was reported by Duplay [ Duplay 1872] in 1872, though the term frozen shoulder was first used in 1934 by Codman[Codman 1934]. 3/29/2021 Frozen Shoulder by Dr. Shazia Khalfe 9

10. Adhesive Capsulitis Adhesive capsulitis, also known as frozen shoulder, is a condition characterized by pain and significant loss of both active range of motion (AROM) and passive range of motion (PROM) of the shoulder . [David et al, 2009] 3/29/2021 Frozen Shoulder by Dr. Shazia Khalfe 10

11. Adhesive Capsulitis It is the condition of uncertain etiology , characterized by significant restriction of both active and passive shoulder motion that occurs in the absence of a known intrinsic shoulder disorder. [Zuckerman JD, 2011] 3/29/2021 Frozen Shoulder by Dr. Shazia Khalfe 11

12. Types of Adhesive Capsulitis 3/29/2021 Frozen Shoulder by Dr. Shazia Khalfe 12

13. Types of Adhesive Capsulitis Primary Adhesive Capsulitis. Secondary Adhesive Capsulitis. [Chan HBY et al, 2017] 3/29/2021 Frozen Shoulder by Dr. Shazia Khalfe 13

14. Primary Adhesive Capsulitis Primary frozen shoulder is idiopathic in nature. It is characterized by the development of dense adhesions, capsular thickening , and capsular restrictions , especially in the dependent folds of the capsule, rather than arthritic changes in the cartilage and bone. [ Kisner & Colby 5 th Ed] 3/29/2021 Frozen Shoulder by Dr. Shazia Khalfe 14

15. Stages of Primary Adhesive Capsulitis “Freezing.” Characterized by intense pain even at rest and limitation of motion by 2 to 3 weeks after onset . These acute symptoms may last 10 to 36 weeks . [ Kisner & Colby 5 th Ed] 3/29/2021 Frozen Shoulder by Dr. Shazia Khalfe 15

16. Stages of Primary Adhesive Capsulitis “ Frozen” there is a decrease in hypervascularity and synovitis however, capsular contraction and thickening is noted on arthroscopic evaluation. There is pain during movement. Atrophy of the deltoid , rotator cuff, biceps, and triceps brachii muscles occurs . This stage lasts 4 to 12 months . [ Kisner & Colby 5 th Ed, Mohanty & Pattnaik , 2015] 3/29/2021 Frozen Shoulder by Dr. Shazia Khalfe 16

17. Stages of Primary Adhesive Capsulitis “Thawing.” Characterized by no pain and no synovitis but significant capsular restrictions from adhesions. This stage lasts 5 to 26 months or longer. Some patients never regain normal ROM . [ Kisner & Colby 5 th Ed] 3/29/2021 Frozen Shoulder by Dr. Shazia Khalfe 17

18. Secondary Adhesive Capsulitis Secondary adhesive capsulitis can occur after shoulder injuries or immobilisation (e.g. rotator cuff tendon tear, subacromial impingement, biceps tenosynovitis and calcific tendonitis). These patients develop pain from the shoulder pathology, leading to reduced movement in that shoulder and thus developing frozen shoulder. [Chan HBY et al, 2017] 3/29/2021 Frozen Shoulder by Dr. Shazia Khalfe 18

19. Epidemiology 3/29/2021 Frozen Shoulder by Dr. Shazia Khalfe 19

20. Epidemiology Adhesive capsulitis is often more prevalent in women, as approximately 70% of individuals who present with a frozen shoulder, are females. 35-65 years old, approximately 2-5% in the general population,  and 20% within the diabetic population .   [Gasper et al, 2009, Kelle et al 2009, Bal et al 2008] 3/29/2021 Frozen Shoulder by Dr. Shazia Khalfe 20

21. In Pakistan The estimated prevalence of FS in diabetics from this data was 41.3 %. (Lahore) A positive family history were associated with a significantly higher prevalence of Adhesive Capsulitis. [Faisal et al, 2017] Frequency of shoulder adhesive capsulitis was 24.9% among diabetic subjects. (Karachi) [ Shakeel A, et al 2012] 3/29/2021 Frozen Shoulder by Dr. Shazia Khalfe 21

22. Clinical Presentation 3/29/2021 Frozen Shoulder by Dr. Shazia Khalfe 22

23. [Sarah Walmsley, et al, 2014, Kisner & Colby] 3/29/2021 Frozen Shoulder by Dr. Shazia Khalfe 23

24. Assessment 3/29/2021 Frozen Shoulder by Dr. Shazia Khalfe 24

25. Subjective Data Medical History : Social History : Medications : History of Present Illness : [The Brigham and Women's Hospital, Inc. Department of Rehabilitation Services 2010] 3/29/2021 Frozen Shoulder by Dr. Shazia Khalfe 25

26. Objective Data Pain : Observation : Postural Assessment : Palpation : Upper Quarter Neuro screen including reflexes, myotomes, dermatomes Range of Motion Muscle Performanc e /Strength: Joint Integrity and Mobility : Special tests : [The Brigham and Women's Hospital, Inc. Department of Rehabilitation Services 2010] 3/29/2021 Frozen Shoulder by Dr. Shazia Khalfe 26

27. Differential Diagnosis A plain X-ray is needed to exclude other pathologies, such as glenohumeral osteoarthritis, locked dislocations and tumours , that can present with active and passive movement restriction and therefore, mimic frozen shoulder. [ Luise Hollmann, 2017] 3/29/2021 Frozen Shoulder by Dr. Shazia Khalfe 27

28. Differential Diagnosis Shoulder Dislocation : Tendonitis or bursitis : Acromioclavicular joint dysfunction : Malignancy : [The Brigham and Women's Hospital, Inc. Department of Rehabilitation Services 2010] 3/29/2021 Frozen Shoulder by Dr. Shazia Khalfe 28

29. Evaluation / Assessment: Diagnosis: 3/29/2021 Frozen Shoulder by Dr. Shazia Khalfe 29

30. Problem List Pain Impaired joint play and ROM in capsular pattern Postural deviations such as protracted scapula and anterior tipping of the scapula and rounded shoulders Decreased arm swing during gait General muscle weakness, poor endurance in glenohumeral (GH) musculature with resultant overuse of the scapular muscles . [The Brigham and Women's Hospital, Inc. Department of Rehabilitation Services 2010] 3/29/2021 Frozen Shoulder by Dr. Shazia Khalfe 30

31. Functional Limitations and Disabilities Difficulty with ADLs requiring reaching overhead, behind head and behind back Unable to lift weighted objects Unable to sustain repetitive UE activities . [ Kisner & Colby Ed 5] 3/29/2021 Frozen Shoulder by Dr. Shazia Khalfe 31

32. Prognosis: Adhesive capsulitis can last 12 to 18 months, with 3 distinct phases. The first phase can last 2-9 months, the second phase 4-12 months and the last phase, the thawing phase , from 6-9 months . [The Brigham and Women's Hospital, Inc. Department of Rehabilitation Services 2010] 3/29/2021 Frozen Shoulder by Dr. Shazia Khalfe 32

33. Goals Demonstrate knowledge of self management of symptoms Demonstrate independent knowledge of home exercise program Increase ROM of all affected motions to equal ROM on the unaffected side Demonstrate normal postural alignment Demonstrate normal UE motion during gait Demonstrate highest level of muscular performance on involved UE and scapular musculature [The Brigham and Women's Hospital, Inc. Department of Rehabilitation Services 2010] 3/29/2021 Frozen Shoulder by Dr. Shazia Khalfe 33

34. Interventions most commonly used ROM exercises including pendulum exercises, PROM, AAROM , AROM TENS for pain relief Strengthening exercises within pain free range Joint mobilization: grades I-II used in the early stages to inhibit pain and to improve joint nutrition, grades III-IV to increase tissue extensibility Moist heat Stretching Muscle reeducation to regain normal GH and scapulothoracic biomechanics [The Brigham and Women's Hospital, Inc. Department of Rehabilitation Services 2010] 3/29/2021 Frozen Shoulder by Dr. Shazia Khalfe 34

35. Frequency & Duration Frequency and duration of treatment are both dependent on the stage that the patient is in . [The Brigham and Women's Hospital, Inc. Department of Rehabilitation Services 2010] 3/29/2021 Frozen Shoulder by Dr. Shazia Khalfe 35

36. Patient / family education Time Frames of healing and of each stage Pathology and natural history of the disorder Role of PT in rehabilitation Home exercise program including strengthening and AROM/AAROM/PROM Pain management techniques Postural awareness education [The Brigham and Women's Hospital, Inc. Department of Rehabilitation Services 2010] 3/29/2021 Frozen Shoulder by Dr. Shazia Khalfe 36

37. Physiotherapeutic Interventions For Frozen Shoulder 3/29/2021 Frozen Shoulder by Dr. Shazia Khalfe 37

38. Pain Relief 3/29/2021 Frozen Shoulder by Dr. Shazia Khalfe 38

39. Improvement In Shoulder Range Of Motion 3/29/2021 Frozen Shoulder by Dr. Shazia Khalfe 39

40. Improvement In Shoulder Function [Jain & Sharma, 2013] 3/29/2021 Frozen Shoulder by Dr. Shazia Khalfe 40

41. Exercises 3/29/2021 Frozen Shoulder by Dr. Shazia Khalfe 41

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49. Summary 3/29/2021 Frozen Shoulder by Dr. Shazia Khalfe 49

50. References Bal A, Eskioglu E, Gulec B, Aydog E, Gurcay E, Cakci A. Effectiveness of corticosteroid injection in adhesive capsulitis. Clinical Rehabilitation 2008; 22:503-512. Codman EA. Tendinitis of the Short Rotators. In: The Shoulder: Rupture of the Supraspinatus Tendon and Other Lesions in or about the Subacromial Bursa. Boston MA: Thomas Todd, 1934 David et al, Frozen shoulder: A clinical review Article in British journal of hospital medicine (London, England: 2005) · June 2009 DOI: 10.12968/hmed.2009.70.5.42225 · Source: PubMed Duplay E. De la periarthrite scapulo-humérale et des raideurs de l`épaule qui en sont la conséquence. Arch Gen Med 1872; 20 : 513-542 Faisal Inayat , 1   Nouman Safdar Ali , 2   Haroon Shahid , 3  and  Fariha Younus 4 , 2017 Prevalence and Determinants of Frozen Shoulder in Patients with Diabetes: A Single Center Experience from Pakistan, Cureus . 2017 Aug; 9(8): e1544. 3/29/2021 Frozen Shoulder by Dr. Shazia Khalfe 50

51. References Gaspar P, Willis B. Adhesive capsulitis and dynamic splinting: a controlled, cohort study. BMC Musculoskeletal Disorders 2009;10:111. Hui Bin Yvonne Chan , Pek Ying Pua , MManipPhty , Choon How How ,2017, Physical therapy in the management of frozen shoulder, Singapore Med J 2017; 58(12): 685-689 doi: 10.11622/smedj.2017107. Kelley M, Mcclure P, Leggin B. Frozen shoulder: Evidence and a proposed model guiding rehabilitation. J Orthop Sports Phys Ther 2009;39:135-148. Kisner & Colby 5th Ed. Chapter 17 . 3/29/2021 Frozen Shoulder by Dr. Shazia Khalfe 51

52. References Luise Hollmann , 2017, Solving the Enigma of Frozen Shoulder, Sydney School of Medicine The University of Sydney Mohanty & Pattnaik , 2015, Physiotherapy for the Shoulder, Chapter 4. Sarah Walmsley, Peter G. Osmotherly , Darren A. Rivett, 2014, Clinical Identifiers for Early-Stage Primary/Idiopathic Adhesive Capsulitis: Are We Seeing the Real Picture? Physical Therapy Volume 94 Number 7 Shakeel Ahmad, Dr. Mohammad Sohail Rafi, Iqbal Ahmed Siddiqui, Khurram Hamidi , Nabiha Mujahid Faruq, 2012 The Frequency Of Adhesive Capsulitis in Diabetes Mellitus Patients. Pakistan Journal of Rehabilitation 2012 Volume 1 (Issue 2 ). 3/29/2021 Frozen Shoulder by Dr. Shazia Khalfe 52

53. References The Brigham and Women's Hospital, Inc. Department of Rehabilitation Services 2010 www.physio-pedia.com/Capsular_and_Noncapsular_Patterns#:~:text=%5B17%5D%20The%20shoulder%20joint%20has,ABD%20limitations%20%3E%20IR%20limitations , Assessed on 9 th July 2020] Zuckerman JD, Rokito A. Frozen shoulder: a consensus definition. J Shoulder Elbow Surg 2011; 20:322-5. 3/29/2021 Frozen Shoulder by Dr. Shazia Khalfe 53

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