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Frozen Shoulder aka Adhesive Capsulitis

also known as adhesive capsulitis basically is an inflammatory painful stiff condition of shoulder joint that develops gradually causing pain which can get worse at night and limits shoulder range of motion.

EPIDEMIOLOGY

It involves individual aging between 40-70 years with mean prevalence of 30% patients with diabetes with higher majority of prevalence among type-1 diabetes patients and lifetime prevalence of frozen shoulder is estimated around 2-5% among general population

CLINICAL FEATURES AND PATHOPHYSIOLOGY

Frozen shoulder can be Primary (Idiopathic) or Secondary (due to any underlying disease) It consists of 3 stages viz. 1. Painful stage 2. Freezing stage 3. Thawing stage Clinically presented with

Pain, Loss of Range of motion, Stiffness

Pain is not localised may radiate to biceps area and deep seated pain in nature it may be localised around anterior or posterior capsule.

PHYSICAL EXAMINATION AND DIAGNOSIS

Adhesive Capsulitis hallmarks loss of range of motion so examine Range of shoulder motion in all planes and movements viz flexion, extension, abduction, adduction, internal and external rotation

For internal rotation its recommended to use Apley’s scratch test

Palpation may reveal diffuse vague tenderness over anterior and posterior shoulder

If loss of motion is observed therapist may apply scapular stabilization and assist movement for accurate testing

Radiography is not that useful however can be performed to rule out other pathology MRI may reveal capsular thickening Basic diagnostic tool is physical examination ROM testing,Palpation etc

Indexes included for measuring frozen shoulder pain and disability

Shoulder Pain and Disability Index

Disability of Shoulder and Hand

Simple Shoulder test

Penn Shoulder Scale

VAS etc

DIFFERENTIAL DIAGNOSIS

Osteoarthritis Shoulder

Rotator Cuff Pathology

PTS syndrome

Biceps tendinopathy

Bursitis

TREATMENT

Medical management include use of corticosteroids, NSAIDS, Intracapsular Corticosteroid injection etc Surgical Management include Arthroscopic surgery, joint manipulation under anaesthesia to break adhesions but has moderate evidence to alleviate pain Physiotherapy is the cornerstone for frozen shoulder techniques include shoulder manipulation and mobilisation, ROM exercise, stretching techniques, Strengthening exercise, Modalities such as ultrasound, iontophoresis, cryotherapy, TENS are used to relieve pain. Physiotherapy along with Corticosteroid injection do miracles and help in long term relief

For Stretching and Strengthening exercises for frozen shoulder visit

https://www.health.harvard.edu/shoulders/stretching-exercises-frozen-shoulder

For more info visit

https://www.physio-pedia.com/Adhesive_Capsulitis

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