Adhesive capsulitis Diagnosis and management Functional assessment tools Q Does the patient have diabetes mellitus? Q Does the patient have thyroid disease? Q Is the patient female? Q Is the patient 40 to 65 years of age? Q Has the patient had a previous episode of adhesive capsulitis in the contralateral shoulder? Yes to any Use validated functional outcome measures, such as the Disabilities of the Arm, Shoulder and Hand, the American Shoulder and Elbow Surgeons shoulder scale, or the Shoulder Pain and Disability Index, 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 Use easily reproducible activity limitation and participation restriction measures associated with shoulder pain to assess the changes in the level of shoulder function over the episode of care. E No to all Clinical presentation 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. E Recognize that adhesive capsulitis occurs as a continuum of pathology characterized by a staged progression of pain and mobility deficits and that, at 12-18 months, mild-to- moderate mobility deficits and pain may persist, though many patients report minimal to no disability. B Recognize that adhesive capsulitis is more prevalent in: females individuals 40-65 years old patients with diabetes mellitus and thyroid disease patients who have had a previous episode of adhesive capsulitis in the contralateral arm. B Clinical examination Assess for impairments in the capsuloligamentous complex and musculotendinous structures surrounding the shoulder complex when a patient presents with shoulder pain and mobility deficits. Elicit loss of passive motion in multiple planes, particularly external rotation with the arm at the side and in varying degrees of shoulder abduction, which is a significant finding that can be used to guide treatment planning. B Obtain measurements of pain, active and passive shoulder ROM to assess the key impairments of body function and body structures in patients with adhesive capsulitis. B Consider assessing glenohumeral joint accessory motion to determine translational glide loss. C Differential diagnosis Q Are some of the patient's reported activity limitations characteristic of adhesive capsulitis? Q Does the patient show an adequate response to treatment for adhesive capsulitis, if already initiated? No to any Consider assessing for alternative diagnoses if the reported activity limitations or impairments of body function and structure are not consistent with the diagnosis/clinical presentation of adhesive capsulitis, or if the patient's symptoms do not respond to treatment. E Yes to all Stretching exercises Instruct patients with adhesive capsulitis to perform stretching exercises, and guide the intensity of the exercises by the patient's tissue irritability level. B Intra-articular corticosteroid injections Perform intra-articular corticosteroid injections in addition to advising shoulder mobility and stretching exercises to improve short-term pain relief and function. A Joint mobilization Consider offering joint mobilization procedures primarily directed to the glenohumeral joint to reduce pain and increase motion and function in patients with adhesive capsulitis. C Electrotherapy Consider performing shortwave diathermy, ultrasound, or electrical stimulation combined with practicing mobility and stretching exercises to reduce pain and improve shoulder ROM in patients with adhesive capsulitis. C Translational manipulation Q Does the patient respond to initial treatment? Yes Consider performing translational manipulation under anesthesia directed to the glenohumeral joint in patients with adhesive capsulitis who are not responding to conservative interventions. C No Consider translational manipulation under anesthesia directed to the glenohumeral joint in patients with adhesive capsulitis who do not respond to conservative treatment. C Patient education Educate patients about the natural course of the disease, promote activity modification to encourage functional, pain-free ROM, and ensure that the intensity of stretching matches to the patient's current level of irritability. B