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Ankylosing Spondylitis

Adhesive Capsulitis

Adhesive Capsulitis is commonly known as a frozen shoulder.

Adhesive capsulitis has a gradual onset of decreased range of motion. Many people notice they have difficulty reaching overhead or behind their back. That's how it's most commonly noticed by the patient.

Who’s at risk?

  • The most common risk factor is diabetes mellitus, especially type I. Adhesive capsulitis affects approximately 10% to 20% of all diabetics.

  • Affects more women than men.

  • Usual onset begins between ages 30 and 65 years.

Other predisposing factors include:

  • A period of enforced immobility, resulting from trauma, overuse injuries or surgery

  • Hyperthyroidism

  • Cervical disk herniation

  • Cardiovascular disease

  • Diabetes mellitus

  • Parkinson’s disease

  • Breast or chest surgery

Causes of frozen shoulder :

  • Most cases of adhesive capsulitis do not have a predisposing risk factor involved and are called idiopathic. The cause of this type of frozen shoulder is unknown, but probably involves an underlying inflammatory process. The capsule surrounding the shoulder joint thickens and contracts. This leaves less space for the upper arm bone (humerus) to move around.

  • Frozen shoulder can also develop after prolonged immobilization because of trauma or surgery to the joint. Usually only one shoulder is affected, although in about 1/3 of cases, motion may be limited in both arms.

  • If a risk factor or predisposing factor is present and treatable, the underlying stiffness and pain in the shoulder will resolve with physical therapy and treatment for the underlying condition.

Stages of (idiopathic) development:

Frozen shoulder develops slowly, and in three stages.

  1.  Stage One: “Freezing”- Pain increases with movement and is often worse at night. There is a progressive loss of motion with increasing pain. This stage lasts approximately 2-9 months.

  2. Stage Two: “Frozen”- Pain begins to diminish, and moving the arm is more comfortable. However, the range of motion is now much more limited, as much as 50 percent less than in the other arm. This stage may last 4-12 months.

  3. Stage Three: “Thawing”- The condition begins to resolve. Most patients experience a gradual restoration  of motion over the next 12-42 months; surgery may be required to restore motion for approximately 5% of patients.

Treatment options:

  • Physiotherapy plays very crucial role in treating this condition. It requires supervised sessions with your physiotherapist for a span ranging from 4 - 12 weeks, depending on severity of the condition.

  • In physiotherapy sessions first pain is targeted then the mobility and then strengthening. Combination of electrotherapy and exercise is used.

  • Treatment is terminated by prescribing patient with home  exercises taught under supervision to be done regularly.

  • Regular follow up with you physiotherapist is very helpful as it helps you to decide status of your condition and avoid worsening of the symptoms

What Your Physio does for Frozen shoulder?

  • Values for sugar levels in diabetes patients, thyroid, blood pressure, VAS scale are measured and documented.Considering the values and age of the patient and the functional goals, exercises are planned.

  • Details about the condition are explained to the patient He /she is taught exercises and told to repeat  3-4 times a day.

  • Every 4-5 days a review is done and change of protocols is done according to the progress. It also helps the patient to monitor self improvement.

  • In some patients for pain relief,new and advance treatments such as kinesio -taping dry needling or cupping is used.Capsular stretching, joint mobility glides and strengthening is also done.

  • Exercise programs are target oriented with  functional and recreational activities, according to the lifestyles and long and short term goals as well.

  • We offer Hydrotherapy also. As water has buoyancy effect ,which facilitates patient to  lift more weight and do more exercises in water.Hydrotherapy helps to reduce pain,strengthening is more and fast,range is improved fast, along with reduction in treatment time.

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By- Dr. Purva Sonegaonkar and Dr. Sheetal Mundhada