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					     PHYSIOTHERAPEUTIC APPROACH TO ADHESIVE CAPSULITIS
Paradoxically shoulder joint privileged as the most mobile joint in the body has its nemesis because of this very advantage. Its
mobility makes it very vulnerable to problems which ultimately “freeze” its movements. Unable to come to terms with the
paucity of liberal movements hitherto enjoyed, the helpless patients generally resigns himself or herself to suffer the agony in
silence. The term „AC‟ should be reserved for a well-defined disorder characterised by progressive pain & stiffness of the
shoulder.The stiffness increases to the point where the natural arm swing that accompanies the normal gait is lost(Rizk &
Pinals, 1982).Approximately 7-15% of patients permanently lose their full ROM, only a few have a true functional
disability(Binder et.al, 1984).Key finding is the pain in the rotator cuff on active abduction, especially at 60 to 100 degree of
abduction. Ultimately, there may be impingement and loss of mobility. The condition is particularly associated with diabetes,
dupytren‟s disease, hyperlipidaemia, hyperthyroidism, cardiac disease and hemiplegia. Although studies comparing various
treatment modalities for AC reveal that no specific treatment method has any long-term advantage, early and accurate
diagnosis is imperative (Bulgen et.al, 1984). Avoiding prolonged immobilisation in patients who may be predisposed to AC is
crucial (Miller et.al, 1996). Treatment of shoulder injury of any etiology requires early ROM therapy to reduce muscle spasm
while maintaining full ROM. Physical therapy done at home including “ Codman‟s exercises”, “climbing the wall”, or “placing
the things up” higher to encourage reaching is cost-effective but requires a long- term rehabilitative process (Wirth &
Rockwood, 1996).Full external rotation of the humerus with the elbow held in a relaxed position at the patient‟s side helps
open up the space, which is difficult to enter if contracted by AC(Larson, 1996). Mobilization and gentle manipulation
technique may also be advicable in the early stages (Maitland, 1983).AC is specially common in stroke victims who are
paralyzed on one side because they are unable to move through a full ROM.
  Thus the first line of treatment is always physiotherapy. Inappropriate aggressive therapy may prolong the symptoms of AC.
  Physical therapy may provide a better outcome. Physical modalities such as myofascial release, massage, ROM exercises
  and US can often release scar tissue (Gam et.al, 1998). It is important to progress physical therapy to include isometric
  strengthening exercises followed by the use of elastic bands .The effectiveness of TENS and cryotherapy in relieving or
  blocking pain is documented. The vast majority of patients with phase II idiopathic AC can be successfully treated with
  specific four-dimensional shoulder stretching exercise. Although manipulation is generally applied, it does not significantly
  improve the outcome (Lundberg, 1969). Based on this review it can be concluded that physiotherapeutic intervention for AC
  should be a multi dimensional approach that vary from patient to patient.
      REFERENCES
     Rizk TE, Pinals RS. Frozen shoulder. Semin Arthritis Rheum 1982;11:440-52.
  Binder AI, Bulgen DY, Hazleman BL, Roberts s. Frozen shoulder. Ann Rheum Dis 1984; 43:361-4
  Bulgen DY, Binder A, Hazleman BL, Park JR. Immunologic studies in frozen shoulder. J. Rheumatol 1982; 9: 893-8.
  Miller MD,Wirth MA , Rockwood CA Jr. Thawing the frozen shoulder . Orthopedics 1996;19:849-53.
  Wirth , MA , blattter , G , and rockwood , CA: The capsular imbrication procedure for recurrent anterior instability of the
  shoulder. J Bone Joint Surg 78A:246, 1996.
  Larson HM, O‟Connor FG, Nirschl RP. Shoulder pain: the role of diagnostic injections. Am Fam Physician 1996; 53:1637
  -47.
  Maitland, GD : Treatment of the glenohumeral joint with passive movement. Physiotherapy 69: 3 , 1983.
  Gam AN, Schydlowsky P, Rossel I, Remvig L, Jensen EM. Treatment of “frozen shoulder” with distension and
  glucocorticoid compared with glucocorticoid alone. A randomized controlled trial. Scand J Rheumatol 1998;27:425-30.
  Lundberg, BJ: The frozen shoulder. Acta Orthop) Scand (Suppl 119:1, 1969.



 Swati Kejriwal
 3rd year
 BPT

				
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