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Unraveling the Mystery of Shoulder Pain #4:

Adhesive Capsulitis(Frozen Shoulder)

Unraveling the Mystery of Shoulder Pain #4:

Adhesive Capsulitis(Frozen Shoulder)

Instructor: Ben Benjamin, Ph.D.Instructor: Ben Benjamin, Ph.D.

Instructor: Ben Benjamin, Ph.D.Instructor: Ben Benjamin, Ph.D.

ben@benbenjamin.comben@benbenjamin.com

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Webinar GoalWebinar Goal

Explore the assessment and treatment of one of the most painful shoulder injuries: Adhesive Capsulitis

LogisticsLogistics• Time: 1 hour

• Schedule:

• Presentation 30–40 min

• Questions 15–20 min

• Ongoing questions: Use Question box.If I don’t get to your question, ask me on my Dr Ben Benjamin Facebook page after the webinar.

• Get a pen and paper please

• Time: 1 hour

• Schedule:

• Presentation 30–40 min

• Questions 15–20 min

• Ongoing questions: Use Question box.If I don’t get to your question, ask me on my Dr Ben Benjamin Facebook page after the webinar.

• Get a pen and paper please

PretestPretest1. Frozen shoulder is most common in:

a. men in their 50sb. women in their 30sc. men and women in their 40sd. women in their 40s

2. The inability to lift the arm overhead is the most important test when assessing adhesive capsulitis. True or False?

3. Resisted tests are of little importance when a frozen shoulder is present. True or False?

4. Traumatic arthritis sets up a pattern of limited movement that is the same for every person who has it. True or False?

5. Which is the most important assessment test when testing for a frozen shoulder?a. passive adductionb. passive lateral rotationc. resisted scapulohumeral abductiond. passive elevation

1. Frozen shoulder is most common in:a. men in their 50sb. women in their 30sc. men and women in their 40sd. women in their 40s

2. The inability to lift the arm overhead is the most important test when assessing adhesive capsulitis. True or False?

3. Resisted tests are of little importance when a frozen shoulder is present. True or False?

4. Traumatic arthritis sets up a pattern of limited movement that is the same for every person who has it. True or False?

5. Which is the most important assessment test when testing for a frozen shoulder?a. passive adductionb. passive lateral rotationc. resisted scapulohumeral abductiond. passive elevation

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AnatomyAnatomy

Shoulder JointsShoulder Joints

• Acromioclavicular

• Sternoclavicular

• Glenohumeral

• Acromioclavicular

• Sternoclavicular

• Glenohumeral

Glenohumeral JointGlenohumeral Joint

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Glenohumeral Joint LigamentsGlenohumeral Joint Ligaments

• Coracohumeral ligament

• Glenohumeral ligaments

• Transverse humeral ligament

• Coracohumeral ligament

• Glenohumeral ligaments

• Transverse humeral ligament

Limits the degrees of movement at the glenohumeral joint

Coracohumeral LigamentCoracohumeral Ligament

Glenohumeral LigamentsGlenohumeral Ligaments

SGHL: superior glenohumeral ligament

MGHL: middle glenohumeral ligament

IGHL: inferior glenohumeral ligament

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Transverse Humeral LigamentTransverse Humeral Ligament

Glenohumeral Joint StructureGlenohumeral Joint Structure

• Shallow joint that permits a huge range of motion

• More range of motion means greater vulnerability to injury

• Shallow joint that permits a huge range of motion

• More range of motion means greater vulnerability to injury

Joint CapsuleJoint Capsule

• Secretes synovial fluid to allow joint bones to glide over one another

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Joint InjuryJoint Injury

Capsular contracture:

• Most limited by anterior adhesions

• Second most limited by inferior adhesions

• Least limited by posterior adhesions

Capsular contracture:

• Most limited by anterior adhesions

• Second most limited by inferior adhesions

• Least limited by posterior adhesions

AssessmentAssessment

Capsular PatternCapsular Pattern

• A characteristic pattern of limitation of a specific joint when it is inflamed

• A characteristic pattern of limitation of a specific joint when it is inflamed

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Assessment TestsAssessment Tests

• Passive Lateral Rotation

• Passive Medial Rotation

• Passive Scapulohumeral Abduction

• Passive Lateral Rotation

• Passive Medial Rotation

• Passive Scapulohumeral Abduction

Passive Lateral RotationPassive Lateral Rotation

Passive Medial RotationPassive Medial Rotation

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Passive Scapulohumeral AbductionPassive Scapulohumeral Abduction

TheoryTheory

• Traumatic Arthritis

• Adhesive Capsulitis

• Frozen Shoulder

• Traumatic Arthritis

• Adhesive Capsulitis

• Frozen Shoulder

Three Names for this Condition:Three Names for this Condition:

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• It hurts to lie on the injured side

• Pain radiates down the arm

• Pain is worse when arm is used

• Motion is very limited

• It hurts to lie on the injured side

• Pain radiates down the arm

• Pain is worse when arm is used

• Motion is very limited

What HappensWhat Happens

• Most often women between 40 and 50 years old

• Also occurs in men

• Most often women between 40 and 50 years old

• Also occurs in men

Who Is AffectedWho Is Affected

• Freezing: Condition worsens for 3-4 months

• Frozen: Pain is constant and steady for 3-4 months

• Thawing: Pain improves gradually over 3-4 months

• Freezing: Condition worsens for 3-4 months

• Frozen: Pain is constant and steady for 3-4 months

• Thawing: Pain improves gradually over 3-4 months

Stages of Frozen ShoulderStages of Frozen Shoulder

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• Spontaneous recovery one year

• Condition persists indefinitely

• Pain decreases or disappears but limitation of movement remains

• Spontaneous recovery one year

• Condition persists indefinitely

• Pain decreases or disappears but limitation of movement remains

Variations in RecoveryVariations in Recovery

Clinical ApplicationClinical Application

A Personal ExperienceA Personal Experience

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• Passive Lateral Rotation –most limited movement, very painful

• Passive Scapulohumeral Abduction – less limited movement and pain

• Passive Medial Rotation –least limited movement and pain

• Passive Lateral Rotation –most limited movement, very painful

• Passive Scapulohumeral Abduction – less limited movement and pain

• Passive Medial Rotation –least limited movement and pain

Assessment Test Resultsfor Frozen Shoulder

Assessment Test Resultsfor Frozen Shoulder

TreatmentTreatment

1st Trimester: Stretching & resisted stretching

2nd Trimester: Stretching & resisted stretching

3rd Trimester: AIS stretching & strengthening

TreatmentTreatment

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Resisted StretchingResisted Stretching

Resisted StretchingResisted Stretching

Resisted StretchingResisted Stretching

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Active Isolated StretchingActive Isolated Stretching

Watch the video at the end of the WebinarWatch the video at the end of the Webinar

QuestionsQuestions

Facebook.com/DrBenBenjaminFacebook.com/DrBenBenjamin

Post-testPost-test1. Frozen shoulder is most common in:

a. men in their 50sb. women in their 30sc. men and women in their 40sd. women in their 40s

2. The inability to lift the arm overhead is the most important test when assessing adhesive capsulitis. True or False?

3. Resisted tests are of little importance when a frozen shoulder is present. True or False?

4. Traumatic arthritis sets up a pattern of limited movement that is the same for every person who has it. True or False?

5. Which is the most important assessment test when testing for a frozen shoulder?a. passive adductionb. passive lateral rotationc. resisted scapulohumeral abductiond. passive elevation

1. Frozen shoulder is most common in:a. men in their 50sb. women in their 30sc. men and women in their 40sd. women in their 40s

2. The inability to lift the arm overhead is the most important test when assessing adhesive capsulitis. True or False?

3. Resisted tests are of little importance when a frozen shoulder is present. True or False?

4. Traumatic arthritis sets up a pattern of limited movement that is the same for every person who has it. True or False?

5. Which is the most important assessment test when testing for a frozen shoulder?a. passive adductionb. passive lateral rotationc. resisted scapulohumeral abductiond. passive elevation