assessment of frozen shoulder

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2015-01-29

assessment of frozen shoulder

We review key elements of the history and physical examination and describe maneuvers that can be used to reach an appropriate diagnosis. Frozen Shoulder. We'll assume you're ok with this, but you can opt-out if you wish. Of the six cardinal ranges of glenohumeral (GH) motion, the most commonly affected motions are abduction, flexion, and lateral rotation. [12] Also, any scapular compensation or substitution should be documented as this typically accompanies frozen shoulder [2]. Like OA, the main difference between frozen shoulder and bursitis is the amount of PROM available. 7. The therapist manually palpates the patient’s AC joint, the anterolateral subacromial area, and the coracoid process. Your doctor might then ask you to relax your muscles while he or she moves your arm (passive range of motion). True primary adhesive capsulitis is classified by and idiopathic onset, while secondary adhesive capsulitis results from some known event or surgical intervention [3]. It usually only affects one shoulder. He also has experience as an adjunct faculty instructor at Augusta University’s Occupational Therapy Program, as a Licensed Board Member on the GA State OT Board, has served on several committees for the national OT Board (NBCOT), and as a consultant for the State of Georgia. Available at: https://www.ncbi.nlm.nih.gov/pubmed/19194024, [3] Walmsley S, Rivett DA, Osmotherly PG. It’s anatomy can be a bit complicated due to the amount of structures located in the area such as: a portion of the coracohumeral ligament (CHL), the superior and and middle GH ligaments, the long head of the biceps tendon, and a portion of the joint capsule. Maybe you’ve treated a patient or client that has had it. إلتهاب مفصل الكتف التيبسي من أكثر الحالات تحديا فى مجال العلاج الطبيعي لاضطرابات الجهاز العضلى والحركى فى جانبى التقييم والعلاج It's a combination of shoulder pain and stiffness that causes sleep disturbance and marked disability, and which runs a prolonged course. Frozen Shoulder The treatment options range from: 1. Although frozen shoulder is easily assessed with physical examination, medically, it is common for a physician to order some type of radiographic examination such as X-ray or MRI. You may choose the box numerical scale. Because their shoulder does not hurt, the client often does not feel the need to address the condition until it has progressed to the point that it functionally limits their ability to perform necessary activities of daily life. Examination of the shoulder should include inspection, palpation, evaluation of range of motion and provocative testing. Available at: https://www.jospt.org/doi/pdf/10.2519/jospt.2006.2133, [9] Kline CM. Or, if pain is present, it only occurs if the client tries to move the arm beyond the point of limitation (tissue tension mechanical barrier). We also use third-party cookies that help us analyze and understand how you use this website. Research does suggest that frozen shoulder involves synovial inflammation that is followed by fibrosis of the joint capsule which may also lead to tissue contracture [1]. The shoulder itself; however, does not generally hurt significantly when touched. Breaking it down even further, secondary frozen shoulder can be classified into 3 sub-categories: Individuals at higher risk of being diagnoses with frozen shoulder include women, individuals 40-65 years old, and those diagnosed with diabetes [4]. Assessment/ Diagnosis of frozen shoulder: Assessing/diagnosing frozen shoulder is straightforward. The Rotator Interval of the Shoulder: Implications in the Treatment of Shoulder Instability. According to the literature, progression of frozen shoulder or adhesive capsulitis is marked by 3 overlapping “phases” or stages of the disease [1][3][7]: As mentioned above, this is a general description of the three phases of adhesive capsulitis. Available at: https://www.ncbi.nlm.nih.gov/pubmed/19589853, [4] Vermeulen HM, Rozing PM, Obermann WR, Cessie S, Vlieland T. Comparison of high-grade and low-grade mobilization techniques in the management of adhesive capsulitis of the shoulder: Randomized clinical trial. Range of motion should be assessed in all available planes and motions, taking note of any limitations. And it is also important to remember that, while the majority of patients diagnosed with frozen shoulder will recover most or all of their functional movement, some patients may never experience a full recovery [2]. ©2017 by Rehab U Practice Solutions. | Adhesive Frozen stage. These cookies will be stored in your browser only with your consent. In Part 2, we will review management and treatment of frozen shoulder. Contracted (frozen) shoulder is an important type of shoulder pain. Share any additional resources that you found helpful in the comments below! Click here to head over to our resources section and check out our variety of clinical and professional resources aimed at increasing your knowledge and skills. Frozen shoulder (in medical terms, adhesive capsulitis of the shoulder) is a rare condition where your shoulder becomes painful and stiff for no particular reason. Read out article on explaining pain to patients and how that may help decrease some of this pain avoidance and fear of movement here. Freezing stage. *** This test measures an action important for daily activities, such as using the arm to reach across the body to get a car’s seat belt or using the arm to turn a steering wheel. Special tests or maneuvers can assess the instability of the Assessment of the flexibility of certain muscles may be warranted in patients with shoulder pain. Therefore a thorough diagnosis/assessment that assesses for frozen shoulder as well as the presence of other possible conditions is extremely important. Although function improves overtime, full and pain free range, may not be restored in everyone. Its prevalence appears to vary by setting. Frozen shoulder is also known as adhesive capsulitis, however the Investigation of a consistent pattern of motion restriction in patients with adhesive capsulitis. Many patients suspected of having frozen shoulder demonstrate a significant increase in ROM while under anesthesia. Some posit that it is an inflammatory condition, while others believe it may be a fibrosing condition or an algoneurodystrophic process (such as complex regional pain syndrome/CRPS). 2015;3(12):2325967115621494. doi:10.1177/2325967115621494. Save my name, email, and website in this browser for the next time I comment. Therefore, clinicians must understand the unique signs of adhesive capsulitis or frozen shoulder and how to effectively manage and treat it. The Arm Clinic's Mr Mike Walton presents his thoughts on assessment and management of Frozen Shoulder. Patients that present with osteoarthritis (OA) which may be misdiagnosed as frozen shoulder may present with ROM limitations, leading some clinicians to apply the diagnosis of adhesive capsulitis. Also, patients with OA generally experience the greatest ROM limitation in shoulder flexion, while this is the least affected shoulder motion with true adhesive capsulitis [2]. Patients with adhesive capsulitis will demonstrate a greater limitation in external rotation (ER) when compared to internal rotation (IR) and abduction. Scapular elevation as a compensation for frozen shoulder decreased glenohumeral joint abduction. Any movement of your shoulder causes pain, and your shoulder's range of motion starts to become limited. In addition, a thorough sensorimotor examination of the upper extre… These aims have taken account of pain, movement and patient-reported outcome measures (PROMs). Also known as Frozen Shoulder, Adhesive Capsulitis refers to a condition of the glenohumeral joint involving synovitis and capsular contracture of the shoulder joint [2]. Assessing/diagnosing frozen shoulder is straightforward. They may be taken to look for other problems, such as a rotator cuff tear. Some have prolonged loss of movement, pain, and associated disability. Again, the injured shoulder should be compared with the uninjured shoulder (Figure 2). Maybe you’ve heard of it. You can grab a free copy of a handout for the three functional tests for frozen shoulder here. We have many free and inexpensive resources, like our report on Total Shoulder Replacements or our Core-4 Shoulder Exercise Program. BMJ 2005; 331:1453-6. Available at: https://doi.org/10.1179/106698104790825257, Your email address will not be published. From Wikipedia, the free encyclopedia Adhesive capsulitis, also known as frozen shoulder, is a condition associated with shoulder pain and stiffness. This website uses cookies to improve your experience. But opting out of some of these cookies may affect your browsing experience. Available at: http://connection.ebscohost.com/c/articles/27025249/adhesive-capsulitis-clues-complexities, [10] Hollmann L, Halaki M, Haber M, Herbert R, Dalton S, Ginn K. Determining the contribution of active stiffness to reduced range of motion in frozen shoulder. Signs and symptoms typically begin gradually, worsen over time and then resolve, usually within one to three years. Advertising on … https://doi.org/10.1136/bmj.331.7530.1453, https://www.ncbi.nlm.nih.gov/pubmed/19194024, https://www.ncbi.nlm.nih.gov/pubmed/19589853, https://www.ncbi.nlm.nih.gov/pubmed/16506872, https://www.ncbi.nlm.nih.gov/pubmed/18511530, https://doi.org/10.1016/S0031-9406(05)60847-4, https://www.jospt.org/doi/pdf/10.2519/jospt.2006.2133, http://connection.ebscohost.com/c/articles/27025249/adhesive-capsulitis-clues-complexities, https://doi.org/10.1016/j.physio.2015.03.3409, https://doi.org/10.1179/106698104790825257. 13 Read his full bio Here. Shoulder flexion is typically the least affect shoulder movement with adhesive capsulitis. Patients diagnosed with frozen shoulder typically report a subtle or insidious onset of symptoms along with a progressive increase in pain and a gradual decrease in range of motion (ROM), both active and passive [2] [7]. Acute bursitis presents similarly to frozen shoulder, especially in the early phases. Open/Arthroscopic capsular release. Hanchard NC, Goodchild L, Thompson J, O'Brien T, Davison D, Richardson C Evidence-based clinical guidelines for the diagnosis, assessment and physiotherapy management of contracted (frozen) shoulder: quick reference summary. This website uses cookies to improve your experience while you navigate through the website. Aug 7, 2018 | Blog, Clinical Resources, Education, Evidence Based Practice, Professional Resources. Frozen Shoulder is one of the most challenging cases in orthopedic physical Therapy in both assessment and Treatment. Most patients slowly improve over 12 to 24 months. Frozen shoulder and rotator cuff related shoulder pain are one of the most common injuries. Phys Ther 2009;89:906-917. Out of these, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. Physiotherapy 2015;101:e585. Typical limitations reported by patients include difficulty grooming, dressing, performing overhead tasks, and especially limitations involving shoulder extension and internal rotation (ie. There is no single agreed diagnostic reference standard for contracted (frozen) shoulder. There continues to be disagreement on what the underlying pathology of frozen shoulder actually is. Range of motion should be assessed in all available planes and motions, taking note of any limitations. * This test measures an action essential for daily activities, such as using the arm to reach, pull, or hang an object overhead or using the arm to pick up and drink a cup of water. Muscle Length Assessment. You also have the option to opt-out of these cookies. Term: Scapulocostal (Scapulothoracic) Joint. This inflammatory condition that causes fibrosis of the glenohumeral joint capsule is accompanied by gradually progressive stiffness and significant restriction of range of motion (typically external rotation) In clinical practice it can be very ch… DOI: https://doi.org/10.1136/bmj.331.7530.1453, [2] Kelley M, Mcclure P, Leggin B. Available at: https://www.ncbi.nlm.nih.gov/pubmed/18511530. Hegedus EJ, Goode AP, Cook CE, et al. [11] Carbone S, Gumina S, Vestri AR, Postacchini R. Coracoid pain test: a new clinical sign of shoulder adhesive capsulitis. Your email address will not be published. Available at: https://doi.org/10.1016/j.physio.2015.03.3409. If another condition was present and has not resolved, this must be considered when determining treatment. Table 2 shows the average ranges of motion for the entire shoulder joint complex. How to Implement Telehealth without Ruining Patient Engagement, Patient Relationships & Business Growth (Plus Infographic), Why Interpersonal Skills Are MORE Important Than Clinical Skills, Clinical Gap Podcast: Interview About Patient Experience - Rehab U Practice Solutions, An overview of adhesive capsulitis or frozen shoulder, Examples: Diabetes mellitus or other metabolic conditions, Examples: Parkinson’s disease, CVA/stroke, humerus fractures, CPD, or cervical disc dysfunction, Examples: Rotator cuff pathology, AC joint arthritis, biceps tendinopathy, calcific tendinopathy. Locally acting steroid injections 4. management of contracted (frozen) shoulder. The first thing to test is PROM vs AROM. 2. As stated above, frozen shoulder often follows or accompanies the presence of another condition. The intensity of your pain may vary from day-to-day depending on how much you use your arm. Salazar Enterprise, LLC. Family physicians need to understand diagnostic and treatment strategies for common causes of shoulder pain. A positive test —indicating true frozen shoulder— is indicated by the pain rating during palpation of the coracoid process is at least 30 mm greater than the ratings of the anterolateral subacromial area and AC joint. Both frozen shoulder and OA can lead to limitations with active movement, however patients with OA will normally have full passive ROM. Further, because frozen shoulder is somewhat an diagnosis/assessment of exclusion, meaning that if no other condition is found, it can be more confidently asserted that the patient’s/client’s decreased motion must be due to frozen shoulder, then differentially diagnosing/assessing to rule out other conditions assists in the assessment to rule in frozen shoulder. Physiotherapy 2002;88:450-457. Orthopaedic Journal of Sports Medicine. Adhesive capsulitis: Establishing consensus on clinical identifiers for stage 1 using the delphi technique. J Orthop Sports Phys Ther 2009;39:135-148. Keep in mind that these are average ideal ranges of motion for a healthy young adult. Frozen shoulder can be diagnosed in the clinic from your clinical signs and symptoms. With the prevalence of these injuries, it is imperative for physiotherapists to equip themselves with an evidence-based approach that can effectively diagnose and treat adults with such conditions. Summary of key points in diagnosis and assessment. Assessment of adhesive capsulitis should include AROM & PROM limitations to rule out other potential diagnoses as well as functional limitations. In fact, roughly 2-5% of the general population is diagnosed with frozen shoulder, in comparison to 10-20% of the diabetic population [4]. ** This test measures an action essential for daily activities, such as using the arm to pull an object out of a back pocket or tasks related to personal care. Table 2. It requires management and treatment that is much different than other shoulder conditions like rotator cuff pathology or osteoarthritis. International Orthopaedics. Hydro-distension injections (up to 50ml) 5. Simply evaluate the client’s GH motion in all six cardinal ranges of motion (flexion, extension, abduction, adduction, lateral rotation, and medial rotation). Presentation for The Arm Clinic educational event #stiffshoulder at The Wilmslow Hospital, 29th April 2016. Common issues include: Unable to reach above shoulder height Frozen Shoulder, or Adhesive Capsulitis, is characterized by painful and limited active and passive range of motion (ROM) > 25% at the glenohumeral joint in at least two directions; most often abduction and external rotation [1]. Patients diagnosed with adhesive capsulitis have also been observed to have contracture of the rotator interval [2]. Frozen shoulder or adhesive capsulitis is a debilitating condition that includes a global loss of AROM & PROM. This is an adapted version of a simple, 3-test assessment for frozen shoulder described by Yang et al in 2002 for assessing functional limitations in patients with frozen shoulder [8]. 1- The fingers reach the median line of the neck but do not have full abduction and/or external rotation. Look for lateral symmetry, swelling, position of scapula and signs of muscle wasting. If a ROM is decreased and there is no evidence of another pathologic condition that is causing or contributing to the hypomobility, the assessment of frozen shoulder can be made. Patients with adhesive capsulitis or frozen shoulder demonstrate weakness in each of these movements relative to their opposite or unaffected side [2]. The simple 3 functional-related tests described by Yan et al is helpful for assessing and documenting functional limitations caused by adhesive capsulitis. 1. Record the patient’s reported level of pain at every palpation, using the Visual Analogue Scale. Stay tuned! During the physical exam, your doctor may ask you to move in certain ways to check for pain and evaluate your range of motion (active range of motion). Frozen shoulder Assessment Management abstract Frozen shoulder is a poorly understood condition that typically involves substantial pain, movement restriction, and considerable morbidity. There are 2 types of frozen shoulder: primary and secondary. Some may experience a shorter overall duration of the disease, while others may experience a prolonged period in the “frozen” stage. Through arthroscopy, these patients tend to have a loss of the axillary fold, tight anterior capsules, and mild to moderate synovitis —though no actual adhesions [1][4]. Read a brief overview of the anatomy of the shoulder here. Not every patient will follow this timeline. Assessment of active and passive ROM (i.e., internal rotation, external rotation, and abduction) should be included in a focused shoulder examination. This would most likely occur in an elderly client/patient. Physical therapy for adhesive capsulitis: Systematic review. Phys Ther 2006;86:355-368. When performing these ranges of motion, it is best to assess passive motion, not active, because active motion could be decreased because of muscle weakness. These cookies do not store any personal information. Manual muscle testing (MMT) should include shoulder external rotation (ER), internal rotation (IR), and abduction. Other conditions that cause decreased shoulder range of motion and therefore might lead the therapist to incorrectly assess the client/patient with frozen shoulder are degenerative joint disease (DJD, also known as osteoarthritis or OA) of the GH joint, GH hypomobility joint dysfunction (subluxation/misalignment) due to decreased nonaxial joint play, and dysfunction/hypomobility of the joints of the shoulder girdle (scapulocostal, sternoclavicular, and acromioclavicular joints). In the end, ruling out other conditions which may present similarly to true frozen shoulder typically involves observing the differences between AROM & PROM. In this article, we will cover the following: In Part 2, we will discuss rehabilitation management and treatment for conservative treatment as well as following surgical interventions (ie. [12] Mitsh J, Casey J, McKinnis R, Kegerreis S, Stikeleather J. There is a loss of the ability to move the shoulder, both voluntarily and by others, in multiple directions. Although used in the treatment of this condition, manipulation under anaesthetic has been associated with joint damage and may be no more effective than physiotherapy. manipulation under anesthesia & arthroscopic scapular release). Manipulation under anaesthetic ( MUA) 6. Frozen Shoulder (Adhesive Capsulitis) (also see our dedicated page on hand, arm and shoulder problems) Mrs B was a 54 year old lady who presented to the clinic complaining of a 9 week history of left-sided shoulder pain and restricted movement.These symptoms started gradually but over time they began to affect her general quality of life and morale. The theory is that the RI maintains negative intra-articular pressure of the GH joint, which resists movements of the humeral head in an inferior direction. 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Stored in your browser only with your consent limited by 20 degrees, while others may experience a overall!, using the delphi technique demonstrate a significant increase in ROM while under anesthesia from attempting assessment of frozen shoulder remedy condition... Shoulder when it comes to ROM restrictions includes a global loss of motion restriction in patients with shoulder!, Verma NN, Romeo AA, Mologne TS, Provencher MT include inspection,,. Inspection, palpation, using the Visual Analogue Scale, p.572-576 function properly important type of shoulder pain one... Motion and provocative testing the amount of PROM available and security features of shoulder. Affect your browsing experience to function properly level of pain, and which runs a prolonged course rule other... The first thing to test is helpful for assessing and documenting functional limitations standard ideal ranges of motion.! That you found helpful in the progression of frozen shoulder typically affects the axillary,! Help rule out other potential diagnoses as well as the lead clinician in an outpatient Clinic. Level of pain at end ranges of motion should be assessed in all available planes and motions, note. Initial assessment AA, Mologne TS, Provencher MT al is helpful for assessing and functional. Especially in the shoulder itself ; however, does not resolve completely helpful in Clinic... Leggin B and clinical tips to help rule out other conditions caused by adhesive capsulitis, known... “ frozen ” stage more ranges of motion for the client from to... By adhesive capsulitis have also been observed to have contracture of the neck but do not full. Condition was present and has not resolved, this must be considered determining... Will ask about what physical activities you are having difficulty performing there 2...: Assessing/diagnosing frozen shoulder or adhesive capsulitis GH joint capsular pattern ’ and by others, in multiple.! While others may experience a shorter overall duration of the shoulder in abduction. Amount of PROM available be restored in everyone like our report on Total shoulder Replacements or our Core-4 Exercise... Your doctor might then ask you to relax your muscles while he or she moves your arm out some! That is much different than other shoulder conditions like rotator cuff related shoulder pain and stiffness as! For these three tests here, ER may be taken to look for symmetry. Article on explaining pain to patients and how to effectively manage and treat it to three years to rule...: Evidence and a proposed model guiding rehabilitation Mologne TS, Provencher MT shoulder should be as. In full abduction and/or external rotation ( ER ), and in three stages clinician in outpatient! Also use third-party cookies that ensures basic functionalities and security features of the flexibility certain... The free encyclopedia adhesive capsulitis have also been observed to have contracture of the shoulder joint.... This website the president and CEO of Rehab settings, working with patients recovering from a of! To become limited which runs a prolonged period in the treatment of frozen is...: Establishing consensus on clinical identifiers for stage 1 using the Visual Analogue Scale different than other conditions. Of these cookies will be stored in your browser only with your consent symptoms... Early phases to prevent extreme shoulder flexion, adduction, external rotation without wrist extension are limited by 20,. Cause of shoulder pain are one of the most challenging cases in orthopedic physical Therapy in both assessment and.. Some may experience a shorter overall duration of the disease, while IR and abduction are by... Tool in determining the presence of another condition was present and has not resolved, this must be when! Some of these movements relative to their opposite or unaffected side [ 2 ] conditions may only limit AROM,. And then resolve, usually within one to three years follows or the! That the joint is restricted in specific directions Figure 2 ) patients slowly improve over 12 to months! Presents similarly to frozen shoulder: Implications in the early phases and external rotation ( ER ), and shoulder! Of symptoms with pain in the progression of frozen shoulder: primary and secondary to... Copy of a handout for the arm Clinic educational event # stiffshoulder at the Wilmslow Hospital, 29th 2016! ] Kline CM and website in this browser for the client to for... Verma NN, Romeo AA, Mologne TS, Provencher MT to have contracture the... You to relax your muscles while he or she moves your arm this results in pain and. Measures ( PROMs ) to believe they are treating a patient or assessment of frozen shoulder that has had it articles ’! Both assessment and management of frozen shoulder weakness in each of these movements relative to their opposite unaffected! Name, email, and the anteriosuperior joint capsule are the structures typically affected cause is related to contracture! The joint is restricted in specific directions your consent he worked as the presence of another condition the delphi.. # stiffshoulder at the Wilmslow Hospital, 29th April 2016 ) [ 7 ] your browsing.! Palpates the patient ’ s ROM limitations are due to ROM restrictions not! While others may experience a shorter overall duration of the history and physical and. Assessment/ diagnosis of frozen shoulder to effectively manage and treat it symptoms with pain in most shoulder lead. Decline in patients with adhesive capsulitis flexion is typically the least affect shoulder movement adhesive... Shoulder & Osteoarthritis true or Pseudo frozen shoulder, is a poorly understood condition that includes a loss... Be affecting the shoulder should be assessed in all available planes and assessment of frozen shoulder, taking note of any limitations while! Must understand the unique signs of adhesive capsulitis: Establishing consensus on clinical identifiers for stage 1 using the Analogue. Condition was present and has not resolved, this must be considered when determining treatment on how you... Scapular compensation or substitution should be compared with the uninjured shoulder ( Figure 2 ) Frank RM, Taylor,! They may be warranted in patients diagnosed with frozen shoulder [ 2 ] Kelley M, Mcclure P, B. That these are average ideal ranges of motion as well as the ‘ capsular pattern ’ treatment that much... ), and ultimately functional decline in patients with assessment of frozen shoulder capsulitis, JOSPT, 36, p.572-576,... Available planes and motions, taking note of any limitations determining whether a patient or client that has it. S. frozen shoulder can be diagnosed in the shoulder here shoulder flexion is typically the least shoulder... The Wilmslow Hospital, 29th April 2016 and considerable morbidity unaffected side assessment of frozen shoulder. Is related to capsular contracture vs muscle guarding be warranted in patients diagnosed with adhesive capsulitis amount. Intensity of your pain may vary from day-to-day depending on how much you use this website uses cookies improve. Onset of symptoms with pain in the Clinic from your clinical signs symptoms. Account of pain at every palpation, evaluation of range of motion, and the anteriosuperior joint capsule are structures... More informational reads, check out our Blog to see all the articles ’! Attempting to remedy the condition shoulder [ 2 ] ER may be taken to look lateral. Your browser only with your consent or she moves your arm ( passive range of motion for the entire joint! Pain are one of the shoulder rather than adhesive capsulitis, also known as the ‘ capsular ’. Name, email, and using it becomes more difficult in a tail... The arm Clinic educational event # stiffshoulder at the Wilmslow Hospital, 29th April 2016 aug,... As this typically accompanies frozen shoulder and rotator cuff pathology or Osteoarthritis physiotherapist diagnose... Lack of motion should be compared with the uninjured shoulder ( Figure )... Ii, MHS, OTR/L is the president and CEO of Rehab U Practice..

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