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Adhesive Capsulitis in Physical Medicine and Rehabilitation Follow-up

  • Author: André Roy, MD, FRCPC; Chief Editor: Stephen Kishner, MD, MHA  more...
 
Updated: Apr 26, 2016
 

Further Outpatient Care

See the list below:

  • The physician and patient together should decide on the most appropriate treatment plan based on the patient's current status and functional goals.
  • Most patients with FS achieve successful outcomes with conservative care.
  • Outpatient follow-up visits should occur on a regular basis (for example, monthly) so that the physician can properly monitor the patient's progress and adjust the treatment plan as needed.
  • See the Treatment section for a discussion of outpatient treatment suggestions.
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Further Inpatient Care

See the list below:

  • In general, treatment and follow-up care for individuals with FS is performed on an outpatient basis; however, for patients who require more aggressive treatment, a short hospitalization may be required.
  • Pain control and maintenance of ROM are common goals after surgical procedures or glenohumeral manipulations that are performed with the patient under anesthesia.
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Deterrence

See the list below:

  • The best treatment for FS is prevention.
  • Early mobilization of the shoulder is crucial in the early stages of FS syndrome.
  • Individuals who do repetitive activities with their upper extremities at work need to pay special attention to their posture and to the ergonomics of their workstation in order to prevent FS.
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Complications

See the list below:

  • Complications of FS include constant pain, loss of functional use of the upper extremity, recurrence, and permanent disability of the shoulder.
  • When patients receive aggressive treatment involving manipulation or surgical intervention, complications may include increased pain, humeral fracture, or neurovascular injury.
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Prognosis

See the list below:

  • The prognosis for patients with FS is generally favorable.
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Patient Education

See the list below:

  • Throughout all stages of the disease process, patient education is an important aspect of treatment for individuals with FS.
    • Patients with FS need to take an active part in their treatment programs to achieve the most successful results.
    • Physical and occupational therapists are valuable members of the treatment team and generally provide a great deal of patient education as part of therapy.
    • Patients should be instructed in a home exercise program to continue working on their ROM and functional abilities.
    • Patients at risk or in the early stages of the disease process must be educated about the disease, especially about prevention strategies.
  • Patients should be advised about the effects of FS and its treatment on their ability to return to work or to resume ADLs.
    • For a manual laborer, an episode of unilateral FS may mean prolonged absence from work, usually for at least 1-3 years. A sedentary office worker may be able to continue working throughout the disease process if given adequate tools to cope with the pain of the illness. These tools may include analgesic medication, the judicious use of injections, use of a TENS unit, and appropriate ergonomic adjustments to his/her workstation.
    • Patients with severe bilateral FS may find that even basic ADLs are a challenge. The loss of ROM during combined extension and internal rotation may make it difficult or impossible for patients with FS to perform many basic daily tasks (eg, toileting, hygiene, dressing, driving, fastening a seat belt). The loss of the combined movements of abduction and external rotation may render it impossible for patients with FS to groom their hair or reach for their seat belt.
    • Patients need to be reminded that improvements in pain and disability after the treatment of FS usually occur over measured months and not over days or weeks. Because 60% of individuals with FS have some permanent residual contracture at the end of the disease process, workers whose tasks require them to move their shoulder to the end of their ROM or to a position of subacromial impingement may have long-term difficulties in resuming their previous job. These individuals may need to adapt their workstations or to change jobs in order to rejoin the workforce. Employees whose job requires repetitive movement of their shoulders or who operate heavy machinery that vibrates may encounter similar difficulties.
  • For excellent patient education resources, visit eMedicineHealth's First Aid and Injuries Center and Osteoporosis Center. Also, see eMedicineHealth's patient education article Shoulder and Neck Pain.
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Contributor Information and Disclosures
Author

André Roy, MD, FRCPC Consulting Staff, Department of Physiatry, Montreal University Hospital Center and Montreal Rehabilitation Institute

André Roy, MD, FRCPC is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Coauthor(s)

Thierry HM Adahan, MD LMCC, CCFP, FRCPC, FABPMR, Head, Pain Rehabilitation Center, Haim Sheba Medical Center, Tel Hashomer, Israel

Thierry HM Adahan, MD is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Patrick M Foye, MD Director of Coccyx Pain Center, Professor and Interim Chair of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School; Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, University Hospital

Patrick M Foye, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, International Spine Intervention Society, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists

Disclosure: Nothing to disclose.

Chief Editor

Stephen Kishner, MD, MHA Professor of Clinical Medicine, Physical Medicine and Rehabilitation Residency Program Director, Louisiana State University School of Medicine in New Orleans

Stephen Kishner, MD, MHA is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine

Disclosure: Nothing to disclose.

Additional Contributors

Curtis W Slipman, MD Director, University of Pennsylvania Spine Center; Associate Professor, Department of Physical Medicine and Rehabilitation, University of Pennsylvania Medical Center

Curtis W Slipman, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists, International Association for the Study of Pain, North American Spine Society

Disclosure: Nothing to disclose.

Acknowledgements

The editors wish to thank Luc Fortin, MD, for his previous contributions to this article.

References
  1. Staples MP, Forbes A, Green S, et al. Shoulder-specific disability measures showed acceptable construct validity and responsiveness. J Clin Epidemiol. 2009 Aug 13. [Medline].

  2. Wohlgethan JR. Frozen shoulder in hyperthyroidism. Arthritis Rheum. 1987 Aug. 30(8):936-9. [Medline].

  3. Hazleman B. Why is a frozen shoulder frozen?. Br J Rheumatol. 1990 Apr. 29(2):130. [Medline].

  4. Lundberg BJ. The frozen shoulder. Clinical and radiographical observations. The effect of manipulation under general anesthesia. Structure and glycosaminoglycan content of the joint capsule. Local bone metabolism. Acta Orthop Scand Suppl. 1969. 119:1-59. [Medline].

  5. Reeves B. The natural history of the frozen shoulder syndrome. Scand J Rheumatol. 1975. 4(4):193-6. [Medline].

  6. Walmsley S, Rivett DA, Osmotherly PG. Adhesive capsulitis: establishing consensus on clinical identifiers for stage 1 using the DELPHI technique. Phys Ther. 2009 Sep. 89(9):906-17. [Medline].

  7. Ogilvie-Harris DJ, Biggs DJ, Fitsialos DP, et al. The resistant frozen shoulder. Manipulation versus arthroscopic release. Clin Orthop Relat Res. 1995 Oct. 238-48. [Medline].

  8. Binder AI, Bulgen DY, Hazleman BL, Roberts S. Frozen shoulder: a long-term prospective study. Ann Rheum Dis. 1984 Jun. 43(3):361-4. [Medline]. [Full Text].

  9. Rizk TE, Pinals RS. Frozen shoulder. Semin Arthritis Rheum. 1982 May. 11(4):440-52. [Medline].

  10. Sano H, Hatori M, Mineta M, et al. Tumors masked as frozen shoulders: A retrospective analysis. J Shoulder Elbow Surg. 2009 Jun 30. [Medline].

  11. Lequesne M, Dang N, Bensasson M, et al. Increased association of diabetes mellitus with capsulitis of the shoulder and shoulder-hand syndrome. Scand J Rheumatol. 1977. 6(1):53-6. [Medline].

  12. Binder AI, Bulgen DY, Hazleman BL, Tudor J, Wraight P. Frozen shoulder: an arthrographic and radionuclear scan assessment. Ann Rheum Dis. 1984 Jun. 43(3):365-9. [Medline]. [Full Text].

  13. Mao CY, Jaw WC, Cheng HC. Frozen shoulder: correlation between the response to physical therapy and follow-up shoulder arthrography. Arch Phys Med Rehabil. 1997 Aug. 78(8):857-9. [Medline].

  14. Clunie G, Bomanji J, Ell PJ. Technetium-99m-MDP patterns in patients with painful shoulder lesions. J Nucl Med. 1997 Sep. 38(9):1491-5. [Medline]. [Full Text].

  15. Carette S, Moffet H, Tardif J, et al. Intraarticular corticosteroids, supervised physiotherapy, or a combination of the two in the treatment of adhesive capsulitis of the shoulder: a placebo-controlled trial. Arthritis Rheum. 2003 Mar. 48(3):829-38. [Medline]. [Full Text].

  16. Green S. Physiotherapy and injection better than injection alone or physiotherapy alone for improving range of motion in adhesive capsulitis. Aust J Physiother. 2003. 49(2):145. [Medline].

  17. Jürgel J, Rannama L, Gapeyeva H, et al. Shoulder function in patients with frozen shoulder before and after 4-week rehabilitation. Medicina (Kaunas). 2005. 41(1):30-8. [Medline]. [Full Text].

  18. Pajareya K, Chadchavalpanichaya N, Painmanakit S, et al. Effectiveness of physical therapy for patients with adhesive capsulitis: a randomized controlled trial. J Med Assoc Thai. 2004 May. 87(5):473-80. [Medline].

  19. Ulusoy H, Sarica N, Arslan S, Olcay C, Erkorkmaz U. The efficacy of supervised physiotherapy for the treatment of adhesive capsulitis. Bratisl Lek Listy. 2011. 112(4):204-7. [Medline].

  20. Griggs SM, Ahn A, Green A. Idiopathic adhesive capsulitis. A prospective functional outcome study of nonoperative treatment. J Bone Joint Surg Am. 2000 Oct. 82-A(10):1398-407. [Medline].

  21. Rizk TE, Christopher RP, Pinals RS, et al. Adhesive capsulitis (frozen shoulder): a new approach to its management. Arch Phys Med Rehabil. 1983 Jan. 64(1):29-33. [Medline].

  22. Rizk TE, Gavant ML, Pinals RS. Treatment of adhesive capsulitis (frozen shoulder) with arthrographic capsular distension and rupture. Arch Phys Med Rehabil. 1994 Jul. 75(7):803-7. [Medline].

  23. Michlovitz SL, Harris BA, Watkins MP. Therapy interventions for improving joint range of motion: A systematic review. J Hand Ther. 2004 Apr-Jun. 17(2):118-31. [Medline].

  24. Russell S, Jariwala A, Conlon R, et al. A blinded, randomized, controlled trial assessing conservative management strategies for frozen shoulder. J Shoulder Elbow Surg. 2014 Apr. 23(4):500-7. [Medline].

  25. Vermeulen HM, Obermann WR, Burger BJ, et al. End-range mobilization techniques in adhesive capsulitis of the shoulder joint: A multiple-subject case report. Phys Ther. 2000 Dec. 80(12):1204-13. [Medline].

  26. Liaw SC. The effect and timing of physiotherapy on change in range of motion and function in frozen shoulder. Physiother Singapore. Sep 2000. 3(3):82-6.

  27. Klç Z, Filiz MB, Çakr T, Toraman NF. Addition of Suprascapular Nerve Block to a Physical Therapy Program Produces an Extra Benefit to Adhesive Capsulitis: A Randomized Controlled Trial. Am J Phys Med Rehabil. 2015 Oct. 94 (10 Suppl 1):912-20. [Medline].

  28. Williams RM, Westmorland MG, Schmuck G, et al. Effectiveness of workplace rehabilitation interventions in the treatment of work-related upper extremity disorders: a systematic review. J Hand Ther. 2004 Apr-Jun. 17(2):267-73. [Medline].

  29. Hazleman BL. The painful stiff shoulder. Rheumatol Phys Med. 1972 Nov. 11(8):413-21. [Medline].

  30. Jacobs LG, Smith MG, Khan SA, et al. Manipulation or intra-articular steroids in the management of adhesive capsulitis of the shoulder? A prospective randomized trial. J Shoulder Elbow Surg. 2009 May-Jun. 18(3):348-53. [Medline].

  31. Favejee MM, Huisstede BM, Koes BW. Frozen shoulder: the effectiveness of conservative and surgical interventions--systematic review. Br J Sports Med. 2011 Jan. 45(1):49-56. [Medline].

  32. Yoon SH, Lee HY, Lee HJ, et al. Optimal dose of intra-articular corticosteroids for adhesive capsulitis: a randomized, triple-blind, placebo-controlled trial. Am J Sports Med. 2013 May. 41(5):1133-9. [Medline].

  33. Lorbach O, Anagnostakos K, Scherf C, et al. Nonoperative management of adhesive capsulitis of the shoulder: oral cortisone application versus intra-articular cortisone injections. J Shoulder Elbow Surg. 2009 Sep 30. [Medline].

  34. Eustace JA, Brophy DP, Gibney RP, Bresnihan B, FitzGerald O. Comparison of the accuracy of steroid placement with clinical outcome in patients with shoulder symptoms. Ann Rheum Dis. 1997 Jan. 56(1):59-63. [Medline]. [Full Text].

  35. Esenyel CZ, Esenyel M, Yesiltepe R, et al. [The correlation between the accuracy of steroid injections and subsequent shoulder pain and function in subacromial impingement syndrome]. Acta Orthop Traumatol Turc. 2003. 37(1):41-5. [Medline].

  36. Naredo E, Cabero F, Beneyto P, et al. A randomized comparative study of short term response to blind injection versus sonographic-guided injection of local corticosteroids in patients with painful shoulder. J Rheumatol. 2004 Feb. 31(2):308-14. [Medline].

  37. Ryans I, Montgomery A, Galway R, et al. A randomized controlled trial of intra-articular triamcinolone and/or physiotherapy in shoulder capsulitis. Rheumatology (Oxford). 2005 Apr. 44(4):529-35. [Medline]. [Full Text].

  38. Vad VB, Sakalkale D, Warren RF. The role of capsular distention in adhesive capsulitis. Arch Phys Med Rehabil. 2003 Sep. 84(9):1290-2. [Medline].

  39. de Jong BA, Dahmen R, Hogeweg JA, et al. Intra-articular triamcinolone acetonide injection in patients with capsulitis of the shoulder: a comparative study of two dose regimens. Clin Rehabil. 1998 Jun. 12(3):211-5. [Medline].

  40. van der Windt DA, Koes BW, Devillé W, Boeke AJ, de Jong BA, Bouter LM. Effectiveness of corticosteroid injections versus physiotherapy for treatment of painful stiff shoulder in primary care: randomised trial. BMJ. 1998 Nov 7. 317(7168):1292-6. [Medline]. [Full Text].

  41. Ranalletta M, Rossi LA, Bongiovanni SL, Tanoira I, Elizondo CM, Maignon GD. Corticosteroid Injections Accelerate Pain Relief and Recovery of Function Compared With Oral NSAIDs in Patients With Adhesive Capsulitis: A Randomized Controlled Trial. Am J Sports Med. 2016 Feb. 44 (2):474-81. [Medline].

  42. Buchbinder R, Green S, Forbes A, Hall S, Lawler G. Arthrographic joint distension with saline and steroid improves function and reduces pain in patients with painful stiff shoulder: results of a randomised, double blind, placebo controlled trial. Ann Rheum Dis. 2004 Mar. 63(3):302-9. [Medline]. [Full Text].

  43. Bunker TD, Anthony PP. The pathology of frozen shoulder. A Dupuytren-like disease. J Bone Joint Surg Br. 1995. 77(5):677-83.

  44. Neer CS 2nd, Satterlee CC, Dalsey RM, et al. The anatomy and potential effects of contracture of the coracohumeral ligament. Clin Orthop. 1992 Jul. (280):182-5. [Medline].

  45. Ozaki J, Nakagawa Y, Sakurai G, et al. Recalcitrant chronic adhesive capsulitis of the shoulder. Role of contracture of the coracohumeral ligament and rotator interval in pathogenesis and treatment. J Bone Joint Surg Am. 1989 Dec. 71(10):1511-5. [Medline].

  46. Andrieu V, Dromer C, Fourcade D, et al. Adhesive capsulitis of the shoulder: therapeutic contribution of subacromial bursography. Rev Rhum Engl Ed. 1998 Dec. 65(12):771-7. [Medline].

  47. Calis M, Demir H, Ulker S, et al. Is intraarticular sodium hyaluronate injection an alternative treatment in patients with adhesive capsulitis?. Rheumatol Int. 2006 Apr. 26(6):536-40. [Medline].

  48. Itokazu M, Matsunaga T. Clinical evaluation of high-molecular-weight sodium hyaluronate for the treatment of patients with periarthritis of the shoulder. Clin Ther. 1995 Sep-Oct. 17(5):946-55. [Medline].

  49. Rovetta G, Monteforte P. Intraarticular injection of sodium hyaluronate plus steroid versus steroid in adhesive capsulitis of the shoulder. Int J Tissue React. 1998. 20(4):125-30. [Medline].

  50. Hsieh LF, Hsu WC, Lin YJ, Chang HL, Chen CC, Huang V. Addition of intra-articular hyaluronate injection to physical therapy program produces no extra benefits in patients with adhesive capsulitis of the shoulder: a randomized controlled trial. Arch Phys Med Rehabil. 2012 Jun. 93(6):957-64. [Medline].

  51. Corbeil V, Dussault RG, Leduc BE, et al. [Adhesive capsulitis of the shoulder: a comparative study of arthrography with intra-articular corticotherapy and with or without capsular distension]. Can Assoc Radiol J. 1992 Apr. 43(2):127-30. [Medline].

  52. Gam AN, Schydlowsky P, Rossel I, et al. Treatment of "frozen shoulder" with distension and glucorticoid compared with glucorticoid alone. A randomised controlled trial. Scand J Rheumatol. 1998. 27(6):425-30. [Medline].

  53. Bell S, Coghlan J, Richardson M. Hydrodilatation in the management of shoulder capsulitis. Australas Radiol. 2003 Sep. 47(3):247-51. [Medline].

  54. Piotte F, Gravel D, Moffet H, et al. Effects of repeated distension arthrographies combined with a home exercise program among adults with idiopathic adhesive capsulitis of the shoulder. Am J Phys Med Rehabil. 2004. 83(7):537-46; quiz 547-9.

  55. Jones DS, Chattopadhyay C. Suprascapular nerve block for the treatment of frozen shoulder in primary care: a randomized trial. Br J Gen Pract. 1999 Jan. 49(438):39-41. [Medline]. [Full Text].

  56. Dahan TH, Fortin L, Pelletier M, et al. Double blind randomized clinical trial examining the efficacy of bupivacaine suprascapular nerve blocks in frozen shoulder. J Rheumatol. 2000 Jun. 27(6):1464-9. [Medline].

  57. Emery P, Bowman S, Wedderburn L, Grahame R. Suprascapular nerve block for chronic shoulder pain in rheumatoid arthritis. BMJ. 1989 Oct 28. 299(6707):1079-80. [Medline]. [Full Text].

  58. Gado K, Emery P. Modified suprascapular nerve block with bupivacaine alone effectively controls chronic shoulder pain in patients with rheumatoid arthritis. Ann Rheum Dis. 1993 Mar. 52(3):215-8. [Medline]. [Full Text].

  59. Shanahan EM, Ahern M, Smith M, Wetherall M, Bresnihan B, FitzGerald O. Suprascapular nerve block (using bupivacaine and methylprednisolone acetate) in chronic shoulder pain. Ann Rheum Dis. 2003 May. 62(5):400-6. [Medline]. [Full Text].

  60. Lin ML, Huang CT, Lin JG, et al. [A comparison between the pain relief effect of electroacupuncture, regional never block and electroacupuncture plus regional never block in frozen shoulder]. Acta Anaesthesiol Sin. 1994 Dec. 32(4):237-42. [Medline].

  61. Buchbinder R, Hoving JL, Green S, et al. Short course prednisolone for adhesive capsulitis (frozen shoulder or stiff painful shoulder): a randomised, double blind, placebo controlled trial. Ann Rheum Dis. 2004 Nov. 63(11):1460-9. [Medline].

  62. Vermeulen HM, Rozing PM, Obermann WR, et al. Comparison of high-grade and low-grade mobilization techniques in the management of adhesive capsulitis of the shoulder: randomized controlled trial. Phys Ther. 2006 Mar. 86(3):355-68. [Medline].

  63. Widiastuti-Samekto M, Sianturi GP. Frozen shoulder syndrome: comparison of oral route corticosteroid and intra-articular corticosteroid injection. Med J Malaysia. 2004 Aug. 59(3):312-6. [Medline].

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