1

ADHESIVE CAPSULITIS

• Adhesive Capsulitis - frozen shoulder.

• Diagnostic term coined in 1945.

• Involves pain and reduced ROM of the gleno-humeral joint.

• The problem lies in the soft tissue of the shouldercapsule rather than the joint structure.

TWO TYPES OF ADHESIVE

CAPSULITIS

• Primary – an idiopathic progressiveloss of motion

• Secondary resulting from a knownintrinsic or extrinsic cause

2

• More females 70% than males 30% are

affected.

• Age group 45-65 years.

• Follows a set diagnostic pattern

– External rotation

– Abduction

– Internal Rotation

OTHER HEALTH FACTORS ASSOCIATED WITH ADEHSIVE CAPSULITIS

• Prolonged immobilisation of the joint• Thyroid disease• Stroke• Heart disease• Autoimmune disease, e.g. rheumatoid arthritis• Hyper-kyphosis ( affecting more females than

males)• Post mastectomy• Diabetes, possibly as a result of increased glucose

levels attaching to collagen surrounding the joint and stiffening surrounding tissues

3

STAGES OF ADHESIVE CAPSULITIS PROGRESSION

• Early freezing stage– Last 2 - 9 months– Gradual reduction ROM– Increase in pain – principally at night,

achy at rest, aggravated by arm movement

– Unknown origin

SECOND, FROZEN STAGE

• Last 4 - 12 months• Pain reduces• ROM greatly reduced or lost entirely• Compensatory movements

4

THIRD, THAWING STAGE

•Lasts 4 - 14 months•Gradual restoration of mobility•Reduction in pain

In 10 – 20% of cases the second shoulder will be affected within 5 years

COMMON SECONDARY COMPLAINTS

• Low back pain• Hypertension• Migraine headaches• Depression, due to lifestyle changes

5

STANDARD MEDICAL TREATMENT

• Exercise, stretching• Oral corticosteriods• Intra-articular injection of corticosteriods

(affects glucose levels)• Hydro-distension – saline solution into

the joint• Manipulation under anesthetic (broken

humerus, symptoms return)• Surgical release• Ignore it

TREATMENT BY PHYSICAL AND REMEDIAL THERAPISTS

• Acupuncture

• Trigger Point Therapy• Massage, petrissage and broad cross

fibre

• Myofascial release therapy

• Passive stretching

6

Myofascial Perspective

1. Treat the pain look elsewhere for the cause

2. Look at postural alignment for stress patterns

3. Look at pelvis and thoracic stability (palpate for constrictions)

4. Look at mechanical stress forces

Posture

Example:If a rubber hose is clamped or tied then water flow is restricted at it’s point of exit

Facial constrictions, e.g. in lower limbs lead to a torsional twisting effecting tissues of the neck and shoulders – restricting blood flow, lymphatics and contributing to meridian congestion

7

Pelvis / Thoracic

Lack of dynamic stability in the deep pelvic and lower back muscles can contribute to degrees of Kyphosis, constriction or even hypermobility in the thoracic regions.

Lack of stability leads to fascial constrictions thus altering the stresses patterns and fluid dynamics of tissues, etc.

Mechanical Stress

Example:

Sitting at a computer for long periods of time keeps the trunk and shoulder in a static condition and creates a holding at the joint (coat-hanger effect).

Reducing postural stresses in the trunk and spine can help reduce the “guarding” of the tissues in the shoulder

8

Basic Protocol Suggestions

1. Case history-postural assessment to deter-mine mechanical and postural stress patterns

1. Palpate constricted tissues – look elsewhere for the cause

2. Treat tissues locally but also treat remotely if appropriate to unwind constrictions that affect stress patterns.

3. Advise treatment plan over at least four sessions and review for effectiveness. Caution against overzealous concurrent treatments that may aggravate treatment plans. Eg, stretching.

ReferencesBarnes JF, 1990 Myofascial Release:The Search for Excellence

Rehabilitation Services Inc., Paoli, PA

Walslaski J, published articlewww.orthomassage.net

Booth T, 2005 Presentation Frozen ShoulderSyndrome to Natural Health Academy of Australia

9

References cont’d……

DM Duschatko, BF Vaughn, JW Beam, B. Ingram-Rice: Adhesive Capsulities –The Frozen Shoulder SyndromeJournal of Bodywork and Movement Therapies, Volume 4 Number 1January 2000, Elsevier Publications

Useful Websites

www.intel.elsevierhealth.com/journals

www.myofascialrelease.com

www.thestretchinghandbook.com