Diagnosis and Rehabilitation Treatment in Adhesive Capsulitis of the Shoulder

ABSTRACT

Adhesive capsulitis was described initially as periarthritis, and then frozen shoulder. Adhesive capsulitis of the shoulder is an insidious, painful condition that results in a gradual restriction of movements. Adhesive capsulitis can be classified into primary or secondary. Primary adhesive capsulitis is an insidious condition, whereas secondary adhesive capsulitis is associated with a known pathology. The pathogenesis remains unclear. Gross pathological changes include thickening and constriction of the capsule, especially anterioinferiorly with a very little amount of synovial fluid in the joint space. Many patients continue to have a significant long-term restriction in their range of motion, although few are functionally restricted. Classically adhesive capsulitis is divided into three phases the painful phase, the stiff phase, and the resolution phase. The diagnosis of adhesive capsulitis is based on a thorough history taking and physical examination. Radiographs of the shoulder are usually negative. An arthrogram may show a decrease in the intraarticular volume and an absence of the axillary recess. The final confirmation of the diagnosis is made by an experience of relief of pain following an intra-articular anesthetic. Prevention is the ideal treatment. The goals of treatment are to relieve pain, to restore motion, and to restore function. Treatment modalities include anti-inflammatory medications, physical therapy including therapeutic exercise, corticosteroid injection, suprascapular nerve block, capsular distension, manipulation under anesthesia, and arthroscopic capsular release. It is necessary to refine the selection of treatment for individual patients according to the phase of the disease.