About Physiatry

About Physiatry

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Adhesive Capsulitis

Condition: Adhesive capsulitis is also referred to frozen shoulder. It is a condition where the capsule that surrounds the humeral head becomes like a tight glove around the humeral head restricting motion.

Background:  Frozen shoulder has a prolong course up to 2 years and greater. It starts with inflammation around the shoulder in the early stages. Later scar tissue develops around the joint.

Risk Factors: At greater risk are women, diabetics, thyroid disorders, breast cancer, heart attack, Parkinson's disease, and after a neurosurgical procedure. Sedentary workers are a greater risk than if you do manual labor.

History and Symptoms: Pain and progressing loss of motion without any cause. Pain often worsens at night. During the early phases when there is inflammation the pain is worse. Later when scar tissue develops pain decreases, with resultant greater loss in range of motion. The process is slow, which can take over two years to resolve

Physical Exam: The doctor will check how far you can move your shoulder in all directions. He will also check your range of motion passively, meaning without any effort by yourself. He will check to see if you can put your palms together as in " prayer position." Also, an evaluation of the strength of your shoulder muscles will be performed. 

Diagnostic Process: Plain x-rays will be ordered to rule out arthritis, or rarely, a tumor. If your condition does not improve, sometimes an MRI will be ordered, which is more sensitive than plain x-rays. 

Rehab Management: Due to the long duration of frozen shoulder, which involves an understanding of therapeutic exercise, the knowledge of Physical Modalities, to restore range of motion, a physical medicine and rehabilitation (PM&R) physician, who is a specialist in rehabilitation of non-operative disorders, can oversee your treatment. Treatment options are medications to decrease inflammation, therapeutic shoulder injections, and prescribing a detailed order to the physical therapist. The PM&R physician will also make sure that you are on a home exercise program, which is critical in managing frozen shoulder. Also, the PM&R physician will need to periodically check your progress to determine if conservative treatment is progressing properly.

Most frozen shoulders respond without the need for surgical interventions, but the PM&R physician, with a thorough understanding of conservative treatment of non-operative orthopedic problems, will know if a surgical consult is needed.

Other Resources for Patients and Families:  It is important that families understand the long-term nature of frozen shoulder, to make sure the patient is doing the home exercise program, and might need assistance in routine self-care activities, dressing, bathing.

 

For Patients and Families:

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