Frozen Shoulder (Adhesive Capsulitis)
Adhesive Capsulitis is a painful condition characterized by severe stiffness and restriction of active and passive glenohumeral motion. It primarily affects the joint capsule, causing it to thicken and contract.
[Image of Frozen Shoulder Capsule Contracture]1. The Three Stages
- Stage 1: Freezing (Painful Phase):
- Duration: 2–9 months.
- Pain is severe, even at rest. Motion starts limiting.
- Stage 2: Frozen (Stiff Phase):
- Duration: 4–12 months.
- Pain decreases, but stiffness is profound. ADLs are difficult.
- Stage 3: Thawing (Recovery Phase):
- Duration: 12–42 months.
- Gradual return of motion.
2. Risk Factors
- Diabetes Mellitus: The strongest risk factor (incidence up to 20%).
- Thyroid Disorders: Hypo/Hyperthyroidism.
- Age/Gender: Most common in women aged 40–60.
3. Clinical Features
Capsular Pattern of Restriction:
External Rotation is the most limited, followed by Abduction, then Internal Rotation.
(ER > Abd > IR)
External Rotation is the most limited, followed by Abduction, then Internal Rotation.
(ER > Abd > IR)
4. Physiotherapy Management
- Pain Phase: Gentle pendulum exercises, Heat, TENS, Grade I/II Maitland mobilization. Avoid aggressive stretching.
- Stiffness Phase: Grade III/IV Mobilization, Sustained stretching, Wand exercises, Shoulder wheel.
- Hydrodilatation: Injection of saline to stretch the capsule (if PT fails).
25 Practice MCQs
Q1. The capsular pattern of the shoulder is restriction of:
Answer: A). External rotation is the most restricted movement.
Q2. Which medical condition has the highest association with Frozen Shoulder?
Answer: B). Diabetics are 5x more likely to develop it.
Q3. The "Freezing" stage is characterized mainly by:
Answer: A). Often misdiagnosed as cuff tendinitis initially.
Q4. Which structure becomes thickened and contracted?
Answer: B). The axillary pouch is obliterated.
Q5. Primary Frozen Shoulder is:
Answer: A). Secondary frozen shoulder has a known cause (trauma/surgery).
Q6. Aggressive stretching is contraindicated in which stage?
Answer: A). Stretching an inflamed capsule increases pain and reaction.
Q7. Manipulation Under Anesthesia (MUA) carries a risk of:
Answer: B). Forceful breaking of adhesions can break osteoporotic bone.
Q8. Which gender is most commonly affected?
Answer: A). Especially peri-menopausal women.
Q9. Which Maitland grade is used for pain relief?
Answer: A). Small amplitude oscillations.
Q10. Hydrodilatation involves injecting:
Answer: B). The pressure ruptures the adhesions.
Q11. The "Shrug Sign" indicates:
Answer: A). Patients compensate for lack of GH motion by elevating the scapula.
Q12. Normal volume of the GH joint capsule is 15-30ml. In frozen shoulder, it reduces to:
Answer: A). Significant reduction in volume.
Q13. Arthroscopic Capsular Release involves cutting the:
Answer: B). These structures are the most contracted.
Q14. Total duration of the disease without treatment is typically:
Answer: B). However, some restriction may remain permanently.
Q15. Which glide improves Abduction?
Answer: A). Based on Convex-Concave rule.
Q16. Which glide improves External Rotation?
Answer: A). Moving the humeral head forward stretches anterior structures.
Q17. A patient has pain only at end-range. They are likely in:
Answer: B). Or late Stage 2.
Q18. Is X-ray diagnostic for Frozen Shoulder?
Answer: B). It is a soft tissue pathology.
Q19. Which modality is best for pre-mobilization heating?
Answer: A). Deep heat improves tissue extensibility.
Q20. Codman's exercises primarily use:
Answer: A). Gentle mobilization.
Q21. Recurrence in the SAME shoulder is:
Answer: A). But risk for the OPPOSITE shoulder is high.
Q22. The "Rotator Interval" contains:
Answer: A). This area is often scarred.
Q23. Hand-behind-back movement combines:
Answer: A). Very restricted in frozen shoulder.
Q24. Steroid injections are most effective in:
Answer: A). Reduces the acute inflammation.
Q25. Which exercise uses a stick/cane?
Answer: A). The good arm pushes the bad arm up.
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