Adhesive Capsulitis in Physical Medicine and Rehabilitation Follow-up

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

Further Outpatient Care

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  • 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

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  • 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

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  • 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

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  • 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

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  • The prognosis for patients with FS is generally favorable.

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Patient Education

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  • 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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