University of North Dakota

UND Scholarly Commons

Physical Therapy Scholarly Projects Department of Physical Therapy

2019

A Case Report: Adhesive Capsulitis and Physical

Therapy Intervention
Haley Brenner
University of North Dakota

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668.
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A Case Report: Adhesive Capsulitis and Physical Therapy Intervention

by

Haley Brenner
Bachelor of Science in Physical Therapy
University of North Dakota, 2018

A Scholarly Project Submitted to the Graduate Faculty of the

Department of Physical Therapy

School of Medicine

University of North Dakota

in partial fulfillment of the requirements for the degree of

Doctor of Physical Therapy

Grand Forks, North Dakota

May, 2019
 This Scholarly Project, submitted by Haley Brenner in partial fulfillment of the
requirements for the Degree of Doctor of Physical Therapy from the University of
North Dakota, has been read by the Advisor and Chairperson of Physical
Therapy under whom the work has been done and is hereby approved.

{Chairperson, Ph

ii
(

PERMISSION

Title A Case Report: Adhesive Capsulitis and Physical Therapy

Intervention

Department Physical Therapy

Degree Doctor of Physical Therapy

In presenting this Scholarly Project in partial fulfillment of the requirements

for a graduate degree from the University of North Dakota, I agree that the
Department of Physical Therapy shall make it freely available for inspection. I
further agree that permission for extensive copying for scholarly purposes may
be granted by the professor who supervised my work or, in her absence, by the
Chairperson of the department. It is understood that any copying or publication
or other use of this Scholarly Project or part thereof for financial gain shall not be
allowed without my written permission. It is also understood that due recognition
shall be given to me and the University of North Dakota in any scholarly use
which may be made of any material in this Scholarly Project.

Signature ~ rl-

Date ]- J 2 - IQ

/
'

iii
 TABLE OF CONTENTS

LIST OF FIGURES ......................................................................... v

LIST OF TABLES ........................................................................ vi

ACKNOWLEDGEMENTS ...............................................................vii

ABSTRACT ................................................................................ viii

CHAPTER
I. BACKGROUND AND PURPOSE ......................... 1

II. CASE DESCRIPTION .......................................... 3

Examination, Evaluation and Diagnosis .................... 3

( Prognosis and Plan of Care .................................... 6

Ill. INTERVENTION ............................................... 7

IV. OUTCOMES ................................................... 10

v. DISCUSSION .................................................... 12

Reflective Practice ............................................. 13

APPENDIX ................................................................................. 15

REFERENCES ............................................................................. 16

(
\

iv
(
\

LIST OF FIGURES

1. Figure 1 ............................................................... ·...................... 8

v
 LIST OF TABLES

1. Table 1 ...................................................................................... 4

2. Table 2 ....................................................................................... 5

3. Table 3 ..................................................................................... 10

vi
(

ACKNOWLEDGEMENTS

I would like to thank my clinical instructor, faculty of the University of North

Dakota physical therapy department, and my classmates for the continual

support and proofreading for the preparation of this case report. I would also like

to thank Nathan Mertens for agreeing to be photographed to further demonstrate

the mobilizations done during this case report and Jayla Greene for assisting in

the photography.

vii
 ABSTRACT

Background and Purpose

The purpose of this case report is to describe the physical therapy

interventions for a patient with adhesive capsulitis.

Case Description

The patient was a 68-year-old right-handed male who presented with left

shoulder pain and limited range of motion (ROM) following a fall 7 months prior.

The patient had a past medical history of type II diabetes mellitus. The diagnosis

of adhesive capsulitis was determined following radiographs, mechanism of

injury, past medical history, and physical therapy examination and evaluation.

Intervention

The patient was seen for a total of 8 physical therapy sessions over the

span of 6 weeks. Interventions included a home exercise program, instruction in

heat/ice use, mobilizations, therapeutic exercises, ROM, stretching, and upper

body ergometer use. Outcome measures included ROM measurements, pain

ratings, strength tests, the Shoulder Pain and Disability Index (SPADI), and the

Patient Specific Functional Scale (PSFS).

Outcomes

Following 6 weeks of physical therapy intervention and home exercise

program, the patient demonstrated increased shoulder ROM,_decreased pain, _

and improved function based on the improved SPADI and PSFS scores

viii
Discussion

Rationale for treatment was based on textbook information for shoulder

interventions and research articles. The treatment was altered based on patient's

response.

Conclusion

This case report is in concordance with the current research that shows

strengthening, mobilizations, a home exercise program and stretching are

appropriate combinations of interventions for individuals with adhesive capsulitis.

This patient returned to his prior level of function following the above treatment

regimen.

ix
 CHAPTER I

BACKGROUND AND PURPOSE

Adhesive capsulitis is a nonspecific chronic inflammatory reaction of

tissues in the glenohumeral joint which causes synovial thickening. This

thickening results in limited range of motion (ROM) most commonly seen in

shoulder abduction and external rotation. Other signs and symptoms include

severe pain at night and pain upon palpation of the anterolateral aspect of the

shoulder. The onset can be insidious or occur after an injury. Secondary

adhesive capsulitis can be the result of an existing shoulder pathology such as a

dislocation, fracture, osteoarthritis, or a neurological condition leading to

muscular imbalances. 1 Risk factors include diabetes, trauma,

hypertriglyceridemia, and thyroid disease. 2

The prevalence rate is reported to be 2-5.3% of the population with

individuals between ages 40-70 most commonly affected. Studies 1 have shown

that adhesive capsulitis affects 20% of people with diabetes. Diabetes can alter

the collagen formation and delay the healing process following traumatic events

or surgery.

Individuals with adhesive capsulitis generally progress through 4 stages:

Prefreezing (1-3 months), Freezing (3-9 months), Frozen (9-14 months), and

Thawing (12-14 months). Interventions for adhesive capsulitis can include

physical therapy, corticosteroid injections, NSAIDs, and surgery. 3 Rawat et al4

( referred to Sahrmann's theory that rotator cuff muscle weakness is often seen in

1
( patients with adhesive capsulitis. Strengthening of the rotator cuff muscles can

restore proper alignment which can decrease pain and improve movement

strategies of the shoulder. A systematic review by Page et al 5 found that

glucocorticoid injections are more effective than manual therapy and exercises in

the short term for decreasing pain, but manual therapy and exercise are more

effective than sham ultrasound to increase range of motion.

The purpose of this case report was to describe the physical therapy

interventions that were done with a patient with adhesive capsulitis and to

describe the outcomes following these interventions. Interventions included

strengthening, stretching, manual therapy, upper body ergometer, and instruction

in a home exercise program.

2
 CHAPTER II

CASE DESCRIPTION

A 68-year-old right-handed male patient was seen in physical therapy 7

months after he fell on the ice. He presented with left shoulder pain and limited

range of motion during the initial evaluation. The patient had a past medical

history of type II diabetes mellitus, hyperlipidemia, hypertension, and obesity. The

diagnosis of adhesive capsulitis was determined following radiographs,

mechanism of injury, past medical history, and physical therapy examination and

evaluation. The patient's chief complaints were decreased ROM, pain, and

decreased ability to independently put on his jacket. His goals for therapy were to
/
f
decrease pain and improve movement of his arm.

Examination, Evaluation and Diagnosis

Upon palpation, patient had tenderness along the left biceps tendon and

coracoid process. Upon observation, patient had a forward head and rounded

shoulders. Examination and evaluation procedure was done according to

Dutton's Orthopaedic Examination, Evaluation, and lnteNention. 3 The

patient's cervical range of motion was within normal limits and painfree. The

initial evaluation included shoulder ROM into flexion, abduction, internal

rotation, functional internal rotation, external rotation, and functional external

rotation (Table 1). The main limitations in range of motion included abduction

and external rotation, which is consistent with the typical presentation of

3
 adhesive capsulitis. \ Functional external rotation was decreased which was

also evident in the patient's inability to effectively put on his jacket.

Table 1. Shoulder Range of Motion Initial Evaluation

Right Left

Flexion 155 155

Abduction 170 135, pain

Internal Rotation 65 (passive) 70 (passive)

Functional T12 T12, pain

internal rotation

External rotation 90 (passive) 53, pain

(
Functional T4 C7, pain

external rotation

4
(
Table 2. Shoulder Strength Initial Evaluation

Right Left

Flexion 5/5 5/5

Abduction 5/5 4, pain

Internal Rotation 5/5 5/5

External Rotation 5/5 5/5

Positive special tests performed on the patient's left shoulder included

Neer's Impingement, Speeds, O'Brien, and empty can tests. Negative tests

included Hawkin's Kennedy, coracoid impingement, crossarm, drop-arm, and

( apprehension tests. The patient's positive special tests did not clearly indicate

what was causing the pain and limited ROM. With the patient's history of

diabetes, decreased active and passive ROM most limited in external rotation,

and his fall on the ice 7 months prior, the diagnosis of adhesive capsulitis was

supported.

5
 Prognosis and Plan of Care

The patient was seen for a total of 8 visits throughout 6 weeks.

Throughout the 8 visits, the patient was provided with a home exercise program

which was updated according to patient's tolerance. Other interventions included

upper body ergometer, shoulder strengthening exercises, stretching, and manual

therapy. Progress notes were completed every fifth visit which consisted of

goniometric and strength measurements, reassessment of goals and patient

reported pain. A Shoulder Pain and Disability Index (SPADI) was given to

measure the functional improvements at initial and final evaluation. The patient

was provided a home exercise program with the following exercises: shoulder

strengthening into flexion, external rotation, and abduction. Stretches included

abduction and external rotation. Exercises during therapy sessions included

various shoulder strengthening and stretching activities. Goniometric

measurements were used to determine progress and ROM improvements.

Manual muscle testing was performed to evaluate increases in shoulder strength.

Shoulder mobilizations were performed at each physical therapy session to

improve ROM. The patient's prognosis was deemed fair. This prognosis was

determined because of his history of diabetes, limited ROM, and SPADI score.

6
 CHAPTER Ill

INTERVENTION

Patient was seen for a total of 8 visits during a 6-week period. The first

session following the evaluation included manual therapy with the patient in

supine. Mobilizations included glenohumeral distraction grade II, glenohumeral

inferior glide grade 11-IV, glenohumeral posterior glide grade II-IV and

glenohumeral posterior glide with external rotation grade II and IV. The

glenohumeral distraction, inferior glide, and posterior glide were done according

to Dutton's Orthopaedic Examination, Evaluation, and Jnte/Vention. 3 The

glenohumeral posterior glide with external rotation mobilization, illustrated in

Figure 1, was performed as described by Johnson et al 6 which showed a

posterior mobilization with external rotation rather than the traditional anterior

mobilization to increase shoulder external rotation.

7
 Figure 1. Posterior Mobilization with External Rotation

( Therapeutic exercises focused on improving shoulder external rotation,

abduction, flexion, and scaption which were all limited motions during the

patient's ROM evaluation. Throughout the sessions, interventions included the

mobilizations mentioned above and therapeutic exercises including left shoulder

external rotation in sidelying, shoulder external rotation in standing, and left

horizontal abduction bent forward at the waist with table support. Active assistive

exercises included left shoulder flexion and left shoulder scaption in supine. The

patient completed 15 repetitions of all exercises and progressed in weight and

sets throughout the sessions. Other exercises included shoulder perturbations

with the patient in supine and proprioceptive exercises with the patient's shoulder

flexed to 90 degrees and standing with his hand against a stability ball. Patient
(
also used an upper body ergometer forward and backward, biceps curl, shoulder

8
 scaption in standing, wall push-ups, shoulder flexion using an exercise ball to roll

up the wall, triceps extension, external rotation stretch in supine using a dowel,

external rotation stretch with palmar surface of hand on· wall, shoulder flexion ball

taps with 5-pound ball clockwise and counterclockwise on agrid on the wall, and
shoulder stretching in supine including flexion, scaption, external rotation, and

internal rotation.

During session 5, an examination was completed to assess how the

patient's pain, strength, and ROM improved over the previous 4 sessions of

physical therapy. The patient reported he could reach behind his back and above

his head with greater ease and, over the previous 2 days, his pain was at 0/10 at

the lowest and 3/10 at the highest. Sleeping, movement in general, and reaching

behind his back all continued to increase his pain.

(
The patient met his short-term goals. Those short-term goals included the

patient will: understand the biomechanical stressors of the shoulder joint in order

to make modifications to activities to reduce further risk of injury, be independent

with a short-term home exercise program, and report pain at worst of 5/10 in

order to perform ADLs.

9
 CHAPTER IV
OUTCOMES
During the patient's last session, a reassessment was done before

discharge. The patient reported he felt he had made 60% improvement since the

initial evaluation and reported he was able to lay on his left arm without

numbness or pain and was sleeping normally. Patient was consistent with his

home exercise program and felt he could independently continue his exercises at

home. He reported his pain at 0/10 at the best and 1-2/1 0 at the worst. The

patient demonstrated increased ROM and strength before discharge (Table 3).

Table 3. Shoulder Range of Motion at Discharge

Right Left
(
Flexion 155 160

Abduction 170 160, no pain

Internal Rotation 65 (passive) 70 (passive)

Functional T12 T12, pain

Internal Rotation

External Rotation 90 (passive) 76

Functional T4 T3

External Rotation

The patient scored 4.7% disability on the SPADI which demonstrated an

( improvement from the initial 17% disability. Patient met all his long-term goals

10
 including: improve score on SPADI by 13 points to correlate with clinically

significant change, patient will report pain at worst of 2/10 or less, patient will

demonstrate 75 degrees or more of shoulder external rotation without pain in

order to manage his coat independently, and patient will demonstrate shoulder

abduction strength of 5/5 without pain.

11
 CHAPTERV
(
DISCUSSION

According to Page et al5 using a combination of manual therapy and

strengthening increased function and range of motion patients with adhesive

capsulitis. Page et al concluded that patients also demonstrated improved

function, decreased pain, and increased range of motion following m~nual

therapy and exercise when compared with sham ultrasound. The authors also

found that glucocorticoid injections were more effective than manual therapy for

pain management. This evidence supports the interventions implemented in this

case study.

The glenohumeral posterior glide with external rotation mobilization was

performed on this patient rather than the traditional anterior mobilization.

Johnson, et al 6 concluded greater improvements in range of motion were seen in

patients that had the posterior glide versus anterior glide done. Further research

should be done with a larger sample size to determine if a posterior mobilization

with external rotation should be the preferred mobilization for patients that need

increased external rotation. For the purpose of this case report, the patient

demonstrated improvements in function and ROM but we were not able to

determine which part of the intervention led to the increased functionality.

During the examination and evaluation of this patient, it was unknown if

there was a specific special test that could have been used to determine if a

patient has adhesive capsulitis. Carbone et aF found 96.4% patients with

adhesive capsulitis had a positive coracoid pain test. Only 11% of patients with
(
;

12
 rotator cuff tears had a positive coracoid pain test, and 2% of patients that were

asymptomatic had a positive coracoid pain test. This test may be beneficial in the

future to determine adhesive capsulitis in patients. The coracoid pain test is one

of few special tests that has high specificity and sensitivity to determine if a

patient has adhesive capsulitis. Further research should be completed to

determine if the coracoid pain test alone could further support a diagnosis of

adhesive capsulitis. Also, further research should be done to determine if the

coracoid pain test can be used in differential diagnosis to separate adhesive

capsulitis from other shoulder pathologies.

This case report is in concordance with the current research that shows

strengthening, mobilizations, a home exercise program and stretching are an

appropriate combination of interventions for individuals with adhesive

capsulitis. 1.4. 5•6 This patient returned to his prior level of function following the

above treatment regimen.

Reflective Practice

Upon review of my clinical practice with this patient, I found that it would

have been beneficial to know about the coracoid pain test to have an easier test

to further determine whether the patient had adhesive capsulitis. In retrospect, I

should have reviewed and changed his home exercise program more often. The

mobilizations were very beneficial to him that we did in physical therapy, so

focusing primarily on the mobilizations during therapy and less time on the

( exercises would have been more efficient. The client had time available outside

13
 /~

\ of physical therapy to do his exercises. With that in mind, rather than having him

do his full exercises every session, I could have either given him new exercises

to keep him motivated or focused more on manual therapy.

After reflecting on my clinical practice, I evaluated my strengths and

weaknesses by creating a Johari Window. 8 The Johari Window examines the

known and unknown factors to the patient and physical therapist. The model

helps to determine outside factors that niay be influential in treatment planning.

One unknown factor and question that I wish I would have asked sooner is if the

patient had any exercise equipment at home. For his first home exercise

program, I gave him theraband to perform shoulder strengthening exercises. In

therapy, we used 1-3 lb. weights to do other strengthening exercises. It wasn't

until the 4th visit that the patient told me he had weights at home. If I would have

asked for that information sooner, I could have given him more exercises to do

and performed other interventions during physical therapy. I also did not know

right away if the patient would consistently perform his home exercises.

However, after the third visit when he demonstrated the exercises without error, I

realized it was not an issue.

Overall, my patient increased in function and range of motion. There are

many factors that influenced his final goal. He was motivated, and hardworking.

He also had a supportive family, functional goals that he wanted to achieve, and

time outside of physical therapy to do his exercises and stretching. All of these

factors and attributes of my patient aided in his recovery.

(
\

14
 /~

APPENDIX

(
\
 REFERENCES
1. Agarwal S, Raza S, Moiz JA, Anwer S, Alghadir AH. Effects of two

different mobilization techniques on pain, range of motion and functional

disability in patients with adhesive capsulitis: A comparative study. Journal

of Physical Therapy Science. 2016;28(12):3342-

3349. https://jlc.jst.go.jp/DN/JLC/20036036132?from=SUMMON. doi:

10.1589/jpts.28.3342.

2. Malik S, Pirotte A. Shoulder. In: Sherman SC. eds. Simon's Emergency

Orthopedics, 7e New York, NY: McGraw-Hill;

2014. http://ezproxylr.med.und.edu:2085/content.aspx?bookid=1132&secti

onid=64416458. Accessed May 22, 2018.

3. Chapter 16. The Shoulder. In: Dutton M. eds. Dutton's Orthopaedic

Examination, Evaluation, and Intervention, 3e New York, NY: McGraw-Hill;

2012. http://accessphysiotherapy.mhmedical.com.ezproxy.undmedlibrary.

org/content.aspx?bookid=4 75&sectionid=40791212. Accessed December

05, 2017.

4. Rawat P, Eapen C, Seema KP. Effect of rotator cuff strengthening as an

adjunct to standard care in subjects with adhesive capsulitis: A

randomized controlled trial. J Hand Ther. 2017;30(3):241.e8. Accessed

Dec 5, 2017. doi: 10.1016/j.jht.2016.10.007.

(
\

16
( 5. Page MJ, GreenS, Kramer S, et al. Manual therapy and exercise for

adhesive capsulitis (frozen shoulder). In: The cochrane library. John Wiley

& Sons, Ltd;

14. http://ezproxylr.med.und.edu:2170/doi/1 0.1 002/14651858.CD011275/f

ull. Accessed Mar 12,2018. 10.1002/14651858.CD011275.

6. Johnson AJ, Godges JJ, Zimmerman GJ, Ounanian LL. The effect of

anterior versus posterior glide joint mobilization on external rotation range

of motion in patients with shoulder adhesive capsulitis. J Orthop Sports

Phys Ther. 2007;37(3):88-99. Accessed Dec 5, 2017. doi:

10 .2519/jospt.2007 .2307.

7. Carbone S, Gumina S, Vestri AR, Postacchini R. Coracoid pain test: A

new clinical sign of shoulder adhesive capsulitis. International

Orlhopaedics.

8. Shenton AK. Viewing information needs through a johari

window. Reference SeJVices Review. 2007;35(3):487-

496. https://www.emeraldinsight.com/doi/abs/1 0.1108/0090732071077433

z. Accessed Jun 5, 2018. doi: 10.1108/00907320710774337.

17
 A Case Report: Adhesive Capsulitis and Physical Therapy Intervention
Haley Brenner SPT, Peggy Mohr PhD, PT
Department ofPhysical Therapy, University ofNorth Dakota School ofMedicine and Health Sciences, Grand Forks, North Dakota 58202-9037

Abstract Case Description Outcomes Discussion

A 68-year-old, right-handed, male patient presented with left Patient reached 5/5 strength (Manual Muscle Test Grading
Research indicated using a combination of manual therapy and
Purpose: The purpose of this case report was to describe the shoulder pain and limited range of motion following a fall 7 System 0-5) in shoulder flexion, abduction, internal rotation, strengthening to increase function and range of motion.
physical therapy interventions for a patient with adhesive months prior. The patient had a past medical history of type 11 and external rotation at final discharge.
diabetes mellitus. The diagnosis of adhesive capsulitis was According to Page et al, patients with adhesive capsulitis
capsulitis. As shown in Table 1., the patient demonstrated an increase of
determined following radiographs, mechanism of injury, past demonstrated improved function, decreased pain, and increased
Case Description: A 68-year-old right-handed male patient 30 degrees in shoulder abduction and 23 degrees improvement
medical history, and physical therapy examination and range of motion following manual therapy and exercise when
who presented with left shoulder pain and limited range of in shoulder external rotation from initial evaluation to final
evaluation. compared with sham ultrasound. The authors also found that
motion (ROM) following a fall 7 months prior. The patient had evaluation.
glucocorticoid injections are more effective than manual
a past medical history of type l1 diabetes mellitus. The diagnosis therapy for pain management.
of adhesive capsulitis was determined following radiographs, Table 1. Left Shoulder ROM
mechanism of injury, past medical history, and physical therapy Plan of Care
examination and evaluation. lnitial evaluation Final Conclusion
Plan of Care: The patient was seen for a total of 8 physical evaluation
therapy sessions over the span of 6 weeks. Interventions
Patient was seen for a total of 8 visits throughout 6 weeks llnciJide'r nexion Tiris case report is in concordance with the current research that
included a home exercise program, instruction in heat/ice use, Patient was given a home exercise program with the following shows strengthening, mobilizations, a home exercise program and
Shoulder abduction 135° 165°
mobilizations, therapeutic exercises, ROM, stretching, and exercises: shoulder strengthening in flexion, external rotation, stretching are an appropriate combinations of interventions for
upper body ergometer use. Outcome measures included ROM and abduction. Stretches included abduction and external individuals with adhesive capsulitis. This patient returned to his
measurements, pain ratings, strength tests, the Shoulder Pain rotation. prior level of function following the above treatment regimen.
and Disability Index (SPADI), and Patient Specific Functional Exercises during therapy sessions included various shoulder
Scale (PSFS). strengthening and stretching activities. Patient improved on SPADI from 17% disability to 4. 7%
Outcomes: Following 6 weeks of physical therapy intervention Goniometric measurements were used to determine progress disability. Ackn.owledgements
and home exercise program, the patient demonstrated increased and ROM improvements. Patient reported 60% improvement in functional activities from
shoulder ROM, decreased pain, and improved function based Manual muscle testing was performed to evaluate increases in initial evaluation to discharge.
I would like to thank my clinical instructor, faculty of the University
on the improved SPADI and PSFS scores. shoulder strength. Patient met all goals prior to discharge. ofNorth Dakota physical therapy department, and my classmates for
Discussion: Rationale for treatment was based on textbook Patient felt he could continue his HEP independently and was the continual support and proofreading for the preparation of this
Shoulder mobilizations were performed at each physical
information for shoulder interventions and research articles. The given progressions. case report. I would also like to thank Nathan Mertens for agreeing
therapy session to improve ROM.
treatment was altered based on patient's response. to be photographed to further demonstrate the mobilizations done
The mobilization in Figure 1. was performed as described by
Conclusion: This case report is in concordance with the current during this case report and Jayla Greene for assisting in the
Johnson et al which showed a posterior mobilization with
research that shows strengthening, mobilizations, a home
external rotation rather than the traditional anterior mobilization
Taxonomy: ICF photography.
exercise program and stretching are an appropriate
increases shoulder external rotation.
combinations of interventions for individuals with adhesive
capsulitis. This patient returned to his prior level of function
Bibliography
following the above treatment regimen.
Kelley MJ, McClure PW, Leggin BG. Frozen shoulder: Evidence and a proposed
model guiding rehabilitation. The Journal of orthopaedic and sports physical
Introduction therapy. 2009;39(2):135~148. http://www.ncbi.nlm.nih.gov/pubmed/19194024.
doi: 10.2519/jospt.2009.2916.
Johnson AJ, Godges JJ, Zimmerman GJ, Ounanian LL. The effect of anterior
versus posterior glide joint mobilization on external rotation range of motion in
Studies have shown that adhesive capsulitis affects 20% of patients with shoulder adhesive capsulitls. J Orthop Sports Phys Ther.
people with diabetes. Diabetes can alter the collagen formation 2007;37(3):88-99. Accessed Dec 5, 2017. dol: 10.2519/jospt.2007.2307.
and delay the healing process following traumatic events or Rawat P, Eapen C, Seema KP. Effect of rotator cuff strengthening as an adjunct
to standard care in subjects with adhesive capsu!itis: A randomized controlled
surgery. trial. J Hand Ther, 2017;30(3):241.e8, Accessed Dec 5, 2017. doi:
The etiology of adhesive capsulitis is not completely 10.1 016/j.jht.2016.1 0.007.
Carbone S, Gumina S, Vestri AR, Postacchini R. Coracoid pain test: A new
understood, but it is most likely caused by a nonspecific chronic clinical sign of shoulder adhesive capsulitis. International Orthopaedics.
inflammatory reaction of tissues in the glenohumeral joint 201 0;34(3):385. https://ezproxylr. med, und. edu:2243/pmc/articles/PMC2899298/.
causing synovial thickening. This thickening leads to a decrease Accessed Mar 11,2018. doi: 10.1007/s00264-009..0791-4.
in shoulder range of motion. a!, Tveita EK , et. Responsiveness of the shoulder pain and disability index in
patients with adhesive capsulitis. ~ PubMed -
Individuals with adhesive capsulitis generally progress through NCBI. https://ezproxylr.med.und.edu:2243/pubrned/19055757. Accessed Mar 11,
2018.
4 stages:
Page MJ, Green S, Kramer S, et al. Manual therapy and exercise for adhesive
-I. Prefreezing (l-3months) capsulitis (frozen shoulder). In: The cochrane library. John Wiley & Sons, Ltd;
2014, http://ezproxylr.med. und. ed u:2170/doi/1 o. 1002/14651858. CD011275/futl.
-2. Freezing (3-9 months)
-3. Frozen (9-14 months) Figure 1. Posterior mobilization with external rotation
ScHooL OF MEDICINE
&.. HEALTH SciENCES
f.l Accessed Mar 12, 2018. 10.1002/14651858.CD011275.

-4. Thawing (12-14 months)