Shoulder Pain and Mobility Deficits: Adhesive Capsulitis

Publication Date: May 1, 2013
Last Updated: March 14, 2022

Recommendations

PATHOANATOMICAL FEATURES

Clinicians should assess for impairments in the capsuloligamentous complex and musculotendinous structures surrounding the shoulder complex when a patient presents with shoulder pain and mobility deficits (adhesive capsulitis). The loss of passive motion in multiple planes, particularly external rotation with the arm at the side and in varying degrees of shoulder abduction, is a significant finding that can be used to guide treatment planning. (E)
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RISK FACTORS

Clinicians should recognize that (1) patients with diabetes mellitus and thyroid disease are at risk for developing adhesive capsulitis, and (2) adhesive capsulitis is more prevalent in individuals who are 40 to 65 years of age, female, and have had a previous episode of adhesive capsulitis in the contralateral arm. (B)
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CLINICAL COURSE

Clinicians should recognize that adhesive capsulitis occurs as a continuum of pathology characterized by a staged progression of pain and mobility deficits and that, at 12 to 18 months, mild to moderate mobility deficits and pain may persist, though many patients report minimal to no disability. (C)
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DIAGNOSIS/CLASSIFICATION

Clinicians should recognize that patients with adhesive capsulitis present with a gradual and progressive onset of pain and loss of active and passive shoulder motion in both elevation and rotation. Utilizing the evaluation and intervention components described in these guidelines will assist clinicians in medical screening, differential evaluation of common shoulder musculoskeletal disorders, diagnosing tissue irritability levels, and planning intervention strategies for patients with shoulder pain and mobility deficits. (F)
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DIFFERENTIAL DIAGNOSIS

Clinicians should consider diagnostic classifications other than adhesive capsulitis when the patient’s reported activity limitations or impairments of body function and structure are not consistent with the diagnosis/classification section of these guidelines, or when the patient’s symptoms are not resolving with interventions aimed at normalization of the patient’s impairments of body function. (F)
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EXAMINATION – OUTCOME MEASURES

Clinicians should use validated functional outcome measures, such as the Disabilities of the Arm, Shoulder and Hand (DASH), the American Shoulder and Elbow Surgeons shoulder scale (ASES), or the Shoulder Pain and Disability Index (SPADI). These should be utilized before and after interventions intended to alleviate the impairments of body function and structure, activity limitations, and participation restrictions associated with adhesive capsulitis. (A)
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EXAMINATION – ACTIVITY LIMITATION MEASURES

Clinicians should utilize easily reproducible activity limitation and participation restriction measures associated with their patient’s shoulder pain to assess the changes in the patient’s level of shoulder function over the episode of care. (F)
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EXAMINATION – PHYSICAL IMPAIRMENT MEASURES

Clinicians should measure pain, active shoulder range of motion (ROM), and passive shoulder ROM to assess the key impairments of body function and body structures in patients with adhesive capsulitis. Glenohumeral joint accessory motion may be assessed to determine translational glide loss. (E)
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INTERVENTION – CORTICOSTEROID INJECTIONS

Intra-articular corticosteroid injections combined with shoulder mobility and stretching exercises are more effective in providing short-term (4-6 weeks) pain relief and improved function compared to shoulder mobility and stretching exercises alone. (A)
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INTERVENTION – PATIENT EDUCATION

Clinicians should utilize patient education that (1) describes the natural course of the disease, (2) promotes activity modification to encourage functional, pain-free ROM, and (3) matches the intensity of stretching to the patient’s current level of irritability. (B)
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INTERVENTION – MODALITIES

Clinicians may utilize shortwave diathermy, ultrasound, or electrical stimulation combined with mobility and stretching exercises to reduce pain and improve shoulder ROM in patients with adhesive capsulitis. (C)
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INTERVENTION – JOINT MOBILIZATION

Clinicians may utilize joint mobilization procedures primarily directed to the glenohumeral joint to reduce pain and increase motion and function in patients with adhesive capsulitis. (C)
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INTERVENTION – TRANSLATIONAL MANIPULATION

Clinicians may utilize translational manipulation under anesthesia directed to the glenohumeral joint in patients with adhesive capsulitis who are not responding to conservative interventions. (C)
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INTERVENTION – STRETCHING EXERCISES

Clinicians should instruct patients with adhesive capsulitis in stretching exercises. The intensity of the exercises should be determined by the patient’s tissue irritability level. (B)
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Recommendation Grading

Overview

Title

Shoulder Pain and Mobility Deficits: Adhesive Capsulitis

Authoring Organization

Publication Month/Year

May 1, 2013

Last Updated Month/Year

May 17, 2023

Supplemental Implementation Tools

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

Describe the peer-reviewed literature and make recommendations related to adhesive capsulitis.

Inclusion Criteria

Female, Male, Adolescent, Adult, Child, Older adult

Health Care Settings

Ambulatory, Emergency care, Hospital, Long term care, Radiology services, School

Intended Users

Physical therapist, occupational therapist, epidemiology infection prevention, chiropractor, athletics coaching, nurse, nurse practitioner, physician, physician assistant

Scope

Counseling, Assessment and screening, Diagnosis, Rehabilitation, Management, Treatment

Diseases/Conditions (MeSH)

D012785 - Shoulder Joint, D020069 - Shoulder Pain

Keywords

Adhesive Capsulitis, shoulder pain, frozen shoulder