Welcome back to another week here at ARC Therapy. Hope everyone has been enjoying these blue skies we’ve all been missing for the past month or so! This week we will be talking about shoulder pain, more specifically adhesive capsulitis which causes mobility deficits. We will be covering clinical presentation, risk factors, clinical course, differential diagnoses and outcomes all from the clinical practice guidelines of the Journal of Orthopedic and Sports Physical Therapy.
Adhesive capsulitis, often referred to as “frozen shoulder” is a self-limiting pathology which causes mobility deficits of the shoulder. Risk factors include those who have pre-existing health conditions such as diabetes mellitus and/or thyroid disease. This condition also happens to be more prevalent in females between the ages of 40 and 65 years, and those who have had previous episodes of adhesive capsulitis in the other shoulder. The course of pathology typically occurs over a continuum of 12-18 months, presenting with mobility deficits and pain with varying levels of disability.
Adhesive capsulitis will typically present as varying degrees of pain with loss of motion, both passive and active, particularly in elevation and rotation. Patients will demonstrate loss of outward rotation and forward/lateral elevation both passive and active which can differentiate it from a musculotendinous injury in which most commonly affects active motion. Examination will typically cover a functional activities questions, pain assessment, range of motion and strength measurements, and joint mobility assessment.
Interventions and treatment include corticosteroid injection, joint and soft tissue stretching and other passive modalities to effectively treat. A combination of corticosteroid injection with stretching within the patient’s pain tolerance has been demonstrated with strong evidence to be more effective at short term (4-6 weeks) pain relief than mobility and stretching exercises only. Moderate evidence suggests patient education to explain the course of pathology, activity modifications to reduce pain, and stretching exercises within patient tolerance. Lastly moderate evidence suggests implementing a mobility and stretching routine within the patient’s tolerance level to be effective in treatment.
Weak evidence suggests passive modalities such as ultrasound and electrical stimulation to be less effective at treatment as well as joint mobilizations. Although these interventions are based on weak evidence, they can still be utilized by your physical therapist to effectively treat your pathology.
If you are having shoulder pain with loss of motion, it may be adhesive capsulitis. We hope this information provided helps you make a decision in the course of treatment you decide. Of course, we would love to see you down here at ARC Therapy for a full evaluation and treatment. As always, we hope you all stay happy and healthy and we look forward to sharing most posts with you in the future!