The document details the case of a 49-year-old female patient diagnosed with idiopathic adhesive capsulitis, highlighting the three stages of the condition and her symptoms, which include significant shoulder pain and limited range of motion. Various assessments, including range of motion tests and manual muscle testing, were conducted, leading to a management plan focused on pain relief and increasing mobility through targeted exercises. After two weeks of physical therapy, the patient's condition showed improvement in both pain levels and functional ability, with a notable decrease in disability scores.

1. ADHESIVE
CAPSULITIS
Manisha
BPT intern 26th batch

2. 3 STAGES
Stage 1 (freezing phase)
Duration : 2-9 months
Stage 2 ( frozen phase)
Duration 3-18 months
Stage 3 (thawing stage )
Duration: beyond 18 months

3. DEMOGRAPHIC DATA
• Name : Prarthana Chaudhary
• Age: 49 years
• Sex: female
• Occupation: housewife
•
• Date of examination: 31.10.2019
• Patient ‘s complaint : inability to lift arm above head level and
difficulty in activities like ,combing ,dressing,
bathing etc due to shoulder pain

4. HISTORY
• Duration of symptoms : 3-4 months
• Onset of symptoms: insidious onset of pain and restriction of movements.
• PAIN
• Location : anterolateral arm and shoulder
• Quality : intermittent
• Intensity : 6-7 on VAS
• Aggravating factors : Overhead activities, touching back ,
• Relieving factor : HWF

5. MEDICAL HISTORY
• Diabetes
• Hypertension
• HISTORY OF TRAUMA
H/o fall or sudden jerk to the shoulder - absent

6. OBSERVATION
POSTURE
• Cervical spine : no forward head posture
• Shoulder : Normal
• Scapula : Normal ( not protracted or abducted)
• Thoracic spine : normal
• Lumbar : normal lordosis present
• Pelvis : no abnormal tilt
• Scapulohumeral rhythm: excessive scapular movements during elevation
in initial phase

7. INSPECTION
• Skin
Color - normal , no signs of inflammation
Scar – not present
• Soft tissue inspection
Swelling- not present
Muscle contours- normal when compared with normal side.
• Gait - inadequate arm swing
• Attitude of affected upper extremity- arm by the side
• End feel : firm

8. MOBILITY
Range of motion:shoulder Active range of motion Passive range of motion
Flexion 120 125°
Extension 20 25
Abduction (frontal plane) 80° 90°
Elevation in scapular
plane
110 120
External rotation with 0°
abduction
10° 12°
Internal rotation with 90°
abduction
25° 30°

9. CERVICAL MOTION
Movements Ranges
Flexion 45°
Extension 60°
(Left )side flexion 40
(Right )side flexion 40
(Left ) rotation 70
(Right ) rotation 70

10. MANUAL MUSCLE TESTING
•Shoulder muscle test in the available range
Muscle group Left shoulder
(affected)
Resisted isometrics
(Affected)
Right shoulder
(normal side)
Flexors 3+ Painfree in neutral
Painful in mid range
5
Extensor 4- Painfree
Abductors 3+ Painful in middle range 5
Adductors 4+ Painfree 5
Horizontal adductors 4+ Painfree 5
External rotators 4- Painfree 5
Internal rotators 4 Painfree 5

11. SCAPULA MUSCLE TEST
Muscle Left (affected) Right (normal)
Serratus anterior Cannot be tested bcoz of pain 5
Middle trapezius 3 +(applying resistance –painful) 5
Lower trapezius Cannot be tested bcoz of
limited range
5
Rhomboids Cannot be tested 5

12. SPECIAL TEST
• Apleys scratch test – positive
ROTATOR CUFF lesion/impingement/tendinitis
.Hawkins Kennedy test-
.speed test –
Empty can test-
* False positive on day 1 because of pain and muscle spasm

13. APLEY’S SCRATCH TEST
Internal rotation with adduction and extension.

14. DIAGNOSIS
• Adhesive capsulitis(idiopathic)
adhesions around the Joint capsule as well as ligaments
and tissues lining the joint capsule.

15. MANAGEMENT
• AIM
1. Pain relief
2. To gain range of motion
3. muscle strengthening
4. Maintain range of motion and muscle strength
5. return to Functional activitise
1. PAIN RELIEF
Hot pack on left shoulder -10 min
To relax muscles ,pain relief and increase pliability of soft tissues.
.Pulsed ultrasound 0.8 W /cm2 to increase extensibility of joint
capsule
. Night pain – cold pack for 15 min

16. DAY 1 &2
Exercise protocol
. Scapular PNF pattern
for scapula stabilization
And pain relief
.hold relax - shoulder adductors
- shoulder extenders
To relax and stretch adductors and extensors
.oscillations for pain relief

17. DAY 3 & 4
• Gental mobilization of shoulder
• Inferior glide
• Posterior glide
• Anterior glide
* 4-5 glides
• .hold relax stretching
• Strengthening in newly gained range.
Manual resistance
Rhythmic stabilization
Dynamic reversals

18. HOME EXERCISE PROTOCOL
1. Codman’s exercises
2. Active assisted flexion
3. Isometric shoulder external /internal rotation
4. Active abduction/against wall
5. Anterior Capsular stretching

19. DAY 5 ONWARDS
• Mobilization of shoulder
10 glides ( inferior ,anterior ,posterior)
• Mobilization with movement for scapula in scaption plane and frontal plane
strengthening (alternating isometrics)
• Hold relax ,contract relax stretching
• Capsular stretching (anterior capsule ,posterior capsule ,inferior capsule)
Finger ladder for active assisted flexion and abduction

20. DAY 14 DAY 1

21. DAY 14 DAY 1

22. RANGE OF MOTION
Movements
(active)
Day 1 Day 14
Flexion 120° 140°
Extension 20 35
External
rotation
(neutral)
ER at 90°abd
10 °
-
30°
20°
Abduction
(frontal
plane)
80° 120°
Internal
rotation
25° 40°
Elevation in
scapular
plane
110 140°

23. DAY 14
• Can reach behind the neck

24. SHOULDER PAIN & DISABILITY INDEX
(SPADI)
Pain scale Before PT management After 2 wks of PT
1. At its worst ?
2. When lying on the involved
side ?
3. Reaching for something on
a high shelf?
4. Touching back of your
neck?
5. Pushing with the involved
arm?
7
5
6
3
7
6
3
5
2
4
5×10=50 28 20
Total pain score (%) (28÷50)×100=56% 40%

25. DISABILITY SCALE
Functional activities Before After 2 wks
1. Washing your hair?
2. Washing your back?
3. Putting on undershirt?
4. Putting on your suit?
5. Putting on your salwar?
6. Placing an object on a high
shelf ?
7. Carring a heavy object ?
8. Removing something from
your back pocket
6
7
5
7
3
7
6
7
4
5
4
5
1
5
5
5
Total disability score 80 48 34
Disability Percentage 60% 42.5%
Total SPADI SCORE 58.46% 41.53%

26. REVIEW
• MMT Shoulder muscles

27. MMT SCAPULAR MUSCLES

28. • Can Hold end position in newly gained range of motion
. Night pain : before treatment 6-7
After PT treatment 2
. Special test
Empty can test – negative
Speed test – negative
SPADI decreased from 58 % to 41%