5/25/2020

Adhesive Capsulitis

The Role of Physical Therapy in Adhesive Capsulitis 

Adhesive capsulitis (frozen shoulder) occurs as the shoulder joint ligaments that hold the shoulder bones to each other become inflamed, prohibiting free movement from the shoulder joint. Risk factors often include a previous shoulder injury or surgery, open-heart surgery, hyperthyroidism, and diabetes in patients. Before a physician prescribes or refers to surgery, patients must often undergo months of nonsteroidal anti-inflammatory medications (NSAIDs) and steroid injections. Recent studies continue to point out the improvement given to patients who undergo physical therapy as part of their rehabilitation after surgery. Physical therapy could also benefit patients without the trauma of surgery.

STUDIES PROVE THE BENEFITS OF PHYSICAL THERAPY

Physical therapy, including joint mobilization, strengthening, and stretching exercises, improves outcomes for patients with adhesive capsulitis. Five studies recently reviewed showed an improvement in patient pain or functional outcomes. Two separate studies found that physical therapy improved shoulder motion and improved functional outcomes such as the patient rating of pain or disability.

The aim of the first study was to determine whether the addition of PT following joint distention improved shoulder ROM and function and to determine if PT is cost-effective. The 144 participants in the study received 6 weeks of treatment totaling 8 visits for 30 minutes each. The PT treatment goals were to improve the glenohumeral joint range of active and passive motion by stretching soft tissue structures around the joint, and to improve strength, particularly within the newly gained passive range; as well as to help patients regain proprioception and normal shoulder and trunk mechanics. The results showed the PT treatment group displayed significant improvements in shoulder motion at 6 and 12 weeks when compared to the control group who received a sham ultrasound.

Another study compared 119 adults (38 male; 81 female) with adhesive capsulitis, defined as shoulder pain and limitation of passive ROM in all directions that interfered with ADL. The aim of the study was to determine the effectiveness of PT in patients with adhesive capsulitis. Both the control group and the study participants were given Ibuprofen treatment consisting of 400mg 3x/day for 3 wks.

Physical therapy consisted of mobilization and passive joint stretching exercises to patient tolerance. The treatment group was also instructed to perform in-home exercise 4 days a week. These included pulley exercises (active-assisted) for 5 minutes and hot packs for 20 minutes followed by active non-assisted exercises using a towel and a wall for 5 minutes. The study results showed after 3 weeks the treatment group had significantly greater improvements in the abduction and internal rotation compared to the control group. In both studies, patients demonstrated dramatic improvement in a relatively short period of time.

A third study looked at the efficacy of an intra-articular steroid injection with physical therapy, alone and in combination, among patients with adhesive capsulitis who were also taught a home exercise program. Study participants received 4 weeks of treatment and were assessed at 3 months, 6 months, and 12 months after the treatment. The 93 adults were given steroid treatments consisting of 40mg Triamcinolone injected into the shoulder joint space under fluoroscopic guidance. The physical therapy treatment consisted of 12 one-hour sessions for 4 weeks (3 sessions/week).

The authors concluded that a corticosteroid injection combined with a home exercise program was effective in improving shoulder pain and disability in patients with adhesive capsulitis and that the addition of supervised PT to corticosteroid treatment provided faster improvements in ROM.

A PHYSICAL THERAPIST CAN HELP

Physical therapy continues to aid patient healing both after surgery and in other treatment plans which may ultimately prevent the need for surgery in the first place. Patients that require surgery are shown to dramatically improve through therapy. The therapist’s role is to reduce patient pain and increase functionality and healing. With quality therapy, patients will be on their way to recovery.



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