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 shoulder
capsule rather than the joint structure.

TWO TYPES OF ADHESIVE

CAPSULITIS
Primary an idiopathic progressive

loss of motion

Secondary resulting from a known

intrinsic or extrinsic cause

 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

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

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

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

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 its 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

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

Basic Protocol Suggestions

1. Case history-postural assessment to determine 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.

References
Barnes JF, 1990 Myofascial Release:
The Search for Excellence
Rehabilitation Services Inc., Paoli, PA

Walslaski J, published article

www.orthomassage.net

Booth T, 2005 Presentation Frozen Shoulder

Syndrome to Natural Health Academy of Australia

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

Useful Websites
www.intel.elsevierhealth.com/journals
www.myofascialrelease.com
www.thestretchinghandbook.com