External Rotation Lag Sign (ERLS) Infraspinatus
Involvement
Slide 5
Lift Off Test Lift Off Test Subscapularis Involvement
Slide 6
Adhesive Capsulitis A pathologic continuum initiated by
synovial inflammation with resultant capsular fibrosis Its
Inflammatory & Fibrosing
Slide 7
Adhesive Capsulitis Patient Profile: Females > Males Females
> Males > 40 years of age > 40 years of age Correlated
with DM Correlated with DM Associated with Thyroid and Autoimmune
Diseases Associated with Thyroid and Autoimmune Diseases Associated
with CVA and MI Associated with CVA and MI History of prolonged
immobilization History of prolonged immobilization
Slide 8
Adhesive Capsulitis 4 Stages Include: (1 3 years) 1 - First 3
months, pain limits rom 1 - First 3 months, pain limits rom 2 - The
freezing Phase, months 3 - 9 2 - The freezing Phase, months 3 - 9 3
- The frozen Phase, months 9 -14 3 - The frozen Phase, months 9 -14
4 - The Thawing Phase, after month 14 4 - The Thawing Phase, after
month 14Types Primary idiopathic Primary idiopathic Secondary
Acquired from a known cause Secondary Acquired from a known
cause
Slide 9
Adhesive Capsulitis Treatment Treatment Medication for pain
Medication for pain Positioning for comfort Positioning for comfort
Education about the disease process Education about the disease
process Gentle rom exercise in the early stages within established
pain parameters Gentle rom exercise in the early stages within
established pain parameters Reassure, Reassure & Reassure
Reassure, Reassure & Reassure
Slide 10
Considerations For Referral Traumatic vs. Insidious Traumatic
vs. Insidious Acute vs. Chronic Acute vs. Chronic Patients Age
& Activity Level Patients Age & Activity Level Acromion
Type Acromion Type Structural Deformity Structural Deformity
Severity of Limitations Severity of Limitations Patients Overall
Health Patients Overall Health Compliance History (In LCR)
Compliance History (In LCR)
Slide 11
Physical Therapy Considerations What is the movement system
diagnosis (independent of the pathophysiologic diagnosis)? What is
the movement system diagnosis (independent of the pathophysiologic
diagnosis)? Are there movement abnormalities that are correctable?
Are there movement abnormalities that are correctable? What
corrective exercise/postural re- education would benefit this
patient? What corrective exercise/postural re- education would
benefit this patient? Compensatory strategies? Compensatory
strategies? Is this patient compliant? Is this patient
compliant?
Slide 12
Bibiliography 1.Davies, George J., Wilk, Kevin, Ellenbecker,
Todd, Et Al., Current Concepts of Orthopaedic Physical Therapy, 2
nd Edition, The Shoulder: Physical Therapy Patient Management
Utilizing Current Evidence. APTA, Orthopaedic Section, 2006.
2.Magee, David J., Orthopedic Physical Assessment, Fourth Edition.
Philadelphia, Saunders, 2002. 3.Neumann, Donald A., Kinesiology of
the Musculoskeletal System, Foundations for Physical
Rehabilitation. St. Louis, Mosby, 2002. 4.Sahrmann S. Diagnosis and
Treatment of Movement Impairment Syndromes. St. Louis, Mosby,
2002.