Advanced

Physiotherapy
Management to
Restore The
Functional
Activities in
Adhesive Capsulitis
 Bio mechanics of
shoulder
The most mobile segment in body
Highly plays with the functional
activities of the distal joints with the
positions providing functional base .
Degrees of freedom when compared
to shoulder it has 3degree of
freedom
Movements of the shoulder
 In congruent surfaces come in
contact while the movement takes
place
 The humeral head has to glide in the
gleniod fossa to improve its
functional component
 Unlike any other joint in body the
mobility depends on ligaments and
muscles equally
 Movements
 Flexion & Extension – Posterior
glide& Anterior glide with Scapular
tucks

Abduction & Adduction – Inferior and

Superior
Glides (Abduction Paradox)

 Rotation components – Int & Ext

Adhesive
Capsulitis
 Pre disposing factors
 Post traumatic
 Post CABG
 Mastectomy- post surgically
 Associated with C spine problems
 Geriatric
 DM
 Definition
Idiopathic restrictions in the shoulder
range of motion characterized by
pain with no bony or muscular lesion
–
WCPT (2006)
[World Council Of
Physical Therapy]
 Classification
as recommended by the APTA [American Physical Therapy
Association]

NEVASIER CLASSIFICATION - 1962

Stage I II III IV
Description Pre Acute Maturation Chronic
adhesive synovitis phase – less stage with
stage with with synovitis fully mature
little or no proliferative which is adhesions
restrictions synovitis demonstrate with
with loss of notable
axillary restriction
fold of of ROM
capsule
Classical complaints
 Age – 35+ ref-JOSPT-II Vol- 2005
 Sex – Male =Female
 Sides – dominant shoulder more
affected
 Pain – dull aching radiating to the
deltoid and lateral aspect of arm
 On examination
 Loss of abduction paradox
 Restriction in a triad movements

Forward Flexion

Abduction

External rotation
 Capsular tightness
 Arm swinging altered
 Donald lykes sign positive
 Medical management
 NSAIDS
 STERIOD INJECTION
 MANUPULATION UNDER ANESTHESIA
 PHYSIOTHERAPY
(TRADITONAL MANGEMENT)
 HOT MODALITIES
 PAIN INHIBITIERS- IFT/TENS

 OVER HEAD EXERCISES

USUALLY DOESENT HELP MUCH JUST A

PAIN RELIEF AND A IMPROVEMENT
OF JOINT RANGE TO JUST 10 TO 20
DEGRES
 What is the
advanced
management
? therapy
Mobilization
Mobilization therapy
 Passive skilled manual therapy
techniques applied to the joints and
soft tissues at various speeds and
amplitudes using physiologic or
accessory movements for therapeutic
purposes

AMTA-1986
 Grade I -Small amplitude rhythmic
oscillations are performed at the
beginning of the range

 Grade II -Large amplitude rhythmic

oscillations are performed at within the
range not reaching the limit

 Grade III -Large amplitude rhythmic

oscillations are performed up to the
available ROM and are stressed into the
tissue resistance
 Grade IV -Small amplitude rhythmic
oscillations are performed at the limit
of available motion and are stressed
into the tissue resistance
 Grade V -A small amplitude high
velocity thrust technique is performed
to snap the adhesions at the limit of
available range of motion
How does manipulation
helps in adhesive
capsulitis?
o The ligamentous restrictions have to
be broken and the intra articular
synovial circulation has to be
improved
o So any exercises which are advised
for the patient will not work to regain
the normal range of motion unless
the capsule is free and cross bridges
have to be broken
Technique of application
Patient to be positioned in a supine
position (abduction) and high sitting
(flexion)shoulder abducted to 80 to
90 degree- slack position of capsule
Then give a gentle traction
Slowly perform the desired movement
by mild oscillatory technique
 Positioning of the arm in – abduction and external
rotation later changed to adduction with internal
rotation in 30 minutes interval
 3 to 4 sessions are done on the day and patient is
discharged on same day evening and he gets a full
ROM acitve
 For pain relief ice application is advised as home
program and in during the admission hourly ice
application – adv easy method and peripheral cooling
inhibits the pain .
 Out come
Pre and Post scoring of the shoulder by
SPADI – SHOULDER PAIN AND
DISABLITY INDEX
THE SCALE HAS GOOD RELIABLITY
AND VALUBLITY – ref Australian journal
of physiotherapy
(consist of 8 components and 0 best score
and worse is 80)
 Home program
 Codman's pendular exercises
 Wand exercises
 Swimming
 Throwing exercises
 Plyometric exercises
 Complication

 By wrong positioning or over

pressure
 Axillary nerve compression
 Post dislocation of shoulder
 Advantages
 Single sitting
 Full range achieved
 Pain relief by local ice application