ADHESIVE CAPSULITIES
(Synonyms:
periarthritis
,FROZEN SHOULDER-).
DEFINITION
It is an clinical syndrome characterized by painful restriction of both active and passive movements of shoulder joint.
Capsular adhesions form due to inflammation in capsule and synovium.
Characterized by progressive stiffness and pain of shoulder usually resolves spontaneously after about 18 months.
•Causes
– primary : idiopathic
-secondary : due to rotator cuff injuries, bicipital tendinitis etc.
– non shoulder causes : diabetes , cardiovascular disease, complication of colle’s fracture.
• Clinical features
– Common in age groups between 40-60 years.
– Decreased range of both active and passive movements.
– Pain is noted at end stage of stretch.
– Accessory joint play is reduced.
– Patient is unable to do daily activities like combing or doing overhead activities etc.
• Clinical stages ( According to Reeves )
✓ Stage 1
– Stage of pain ( Freezing )
– Acute pain
– Decreased movement
– Last for 10-36 weeks.
✓ Stage 2
– Stage of stiffness ( Frozen )
– Pain gradually decreases.
– Patient complains of stiff shoulder.
– Last for 12-14 weeks.
✓ Stage 3
– Stage of Recovery ( Thawing )
– No pain with recovery of movement , but will not be regained to normal.
– Last for 6 months to 2 years .
• Radiological features.
– X-ray is usually normal.
-may show sclerosis in few cases.
– Reduce bone density if diffuse.
• Diagnostic test
– Active test of ROM with slight overpressure at terminal point of each movement.
– Active resisted test
– Passive test.
• Treatment
– Conservative treatment ( Stage 1 )
– Analgesics and anti-inflammatory drugs.
– PT management ( stage 2 )
– Ultrasound , heat and pendular exercise .
– Active and passive exercise.
– Manipulation can be done under general anaesthesia.
✓ Surgical management ( Stage 3 )
– Arthroscopic capsular release .
