ADHESIVE CAPSULITIS

- In 1934, Codman coined the term frozen shoulder but used it in association with tendinitis of
the rotator cuff.

- the inflamed and fibrotic condition of the capsuloligamentous tissue (Nevaiser)

- a condition difficult to define, difficult to treat, and difficult to explain from the point of view of
pathology (Codman)

- this term have been used to denote a common chronic affectation characterized by pain and
limitation in shoulder motion. (Brashear and Raney, p. 468)

- intracapsular inflammation (OSullivan, p. 689)

- is characterized by painful, restricted shoulder ROM in patients with normal radiographs.

- is characterized by the development of dense adhesions, capsular thickening, and capsular

restrictions, especially in the dependent folds of the capsule, rather than arthritic changes in the
cartilage and bone, as seen with rheumatoid arthritis or osteoarthritis. (Colby and Kisner, p. 546)

- is usually an idiopathic condition but can be associated with diabetes mellitus, inflammatory
arthritis, trauma, prolonged immobilization, thyroid disease, cerebrovascular accident,
myocardial infarction, or autoimmune disease. Pathologic evaluation can reveal perivascular
inflammation, but the predominant abnormality is fibroblastic proliferation with increased
collagen and nodular band formation. (Braddom)

I. DEFINITION OF TERMS

A. SHOULDER - a ball-and-socket joint made up of three bones: your upper arm bone
(humerus), your shoulder blade (scapula), and your collarbone (clavicle).

B. JOINT - or articulation (or articular surface) is the connection made between bones in the
body. They are constructed to allow for different degrees and types of movement.

C. RANGE OF MOTION - is a basic technique used for the examination of movement and for
initiating movement into a program of therapeutic intervention. Movement that is necessary to
accomplish functional activities can be viewed, in its simplest form, as muscles or external
forces moving bones in various patterns or ranges of motions.
D. STIFFNESS - the feeling that the motion of a joint is limited or difficult. The feeling is not
caused by weakness or reluctance to move the joint due to pain.

E. LIGAMENT - s the fibrous connective tissue that connects bones to other bones and is also
known as articular ligament, articular larua, fibrous ligament, or true ligament.

F. STAGES OF FROZEN SHOULDER

1. Stage 1 typically lasts for up to 3-4 months from the onset of symptoms, is known as
the Inflammation Stage. In Stage 1, your shoulder is painful and this pain limits your
shoulder movement. The pain is caused by inflammation of the lining of the shoulder.

2. The second stage, occurring during months 3-9, is known as the Freezing Stage. In
Stage 2, your shoulder continues to be painful and begins to stiffen. The pain may slowly
decrease for the next several months. The loss of shoulder motion in this stage is due to
inflammation of the lining of your shoulder and progressive shrinking and thickening of
the shoulder capsule (the sleeve that surrounds the shoulder).

3. In Stage 3, the Frozen Stage, which occurs over months 9-14, your shoulder is stiff,
but is no longer painful at rest. The shoulder capsule is scarred, thickened and tighter
than normal. The scarring limits range of motion and can cause pain associated with
stretching or reaching movements.

4. Stage 4. The Thawing Stage occurs 15-24 months into the condition. Your shoulder
motion gradually returns, and the function of your shoulder steadily improves.