Adhesive capsulitis
CONSULT TREATMENT PROTOCOL

ANATOMICAL AREAS



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GLOSSARY OF DISEASES

NameTissueType of pathologies
Acute and chronic muscle aches and pain Muscle Pain management
Acute and chronic cervical and lumbar pain Muscle Idiopathic cervical and low back pain
Acute and chronic soft tissue wounds Skin Wounds
Adhesive capsulitis Joint Capsulitis
Calcifying tendinitis of the shoulder Tendons Tendinopathy
Cellulite Skin Cellulite
Chronic distal biceps tendinopathy Tendons Tendinopathy
Chronic proximal hamstring tendinopathy Tendons Tendinopathy
Diseases secondary to trigger points and myofascial Pain Muscle Myofascial pain syndrome
Golfer’s elbow Tendons Tendinopathy
Greater trochanteric pain syndrome Tendons Tendinopathy
Insertional Achilles tendinopathy Tendons Tendinopathy
Knee osteoarthritis Joint Osteoarthritis
Medial tibial stress syndrome Tendons Tendinopathy
Mid-body Achilles tendinopathy Tendons Tendinopathy
Osgood-Schlatter disease Bone Disturbance of musculoskeletal development
Patella tip syndrome Tendons Tendinopathy
Plantar fasciopathy Tendons Tendinopathy
Primary and secondary lymphedema Skin Lymphedema
Primary long bicipital tenosynovitis Tendons Tendinitis
Proliferative connective tissue disorders Connective tissue Fibrosis
Spasticity Central nervous system Cerebral palsy and stroke
Stress fractures Bone Fracture
Subacromial pain syndrome Tendons Tendinopathy
Superficial nonunions Bone Fracture
Tennis elbow Tendons Tendinopathy
Trigger points Muscle Myofascial pain syndrome
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MORE INFORMATION

Primary shoulder adhesive capsulitis (pSAC) occurs without any known precipitating cause. According to the American Shoulder and Elbow Surgeons (www.ases-assn.org) pSAC is defined as a condition of uncertain etiology characterized by significant restriction of both active and passive shoulder motion that occurs in the absence of a known intrinsic shoulder disorder.

There are a number of predisposing conditions for developing pSAC including prolonged shoulder immobility secondary to trauma or surgery. There is also evidence that the use of protease inhibitors as antiretroviral therapy may predispose to the development of pSAC.
Diagnosis is based on the clinical features of the disease.

The four clinical stages of pSAC are defined as follows:
(i) Painful stage (<3 months) with aching pain and moderate limitation of the range of motion (ROM);
(ii) Freezing stage (3-9 months) with severe pain and reduction of ROM;
(iii) Frozen stage (9-14 months) with predominant stiffness that may be accompanied by pain;
and (iv) Thawing stage (15-24 months) with minimal pain and gradual improvement of ROM.

Biopsies of the shoulder capsule from patients with pSAC showed the following stage-related pathologies: synovitis and capsular hypertrophy during the painful stage, perivascular synovitis and disorganized collagen deposition during the freezing stage, and dense and hypercellular collagenous tissue during the frozen stage (thawing stage not yet investigated).

The lifetime prevalence of pSAC is approximately 3-5%, with women (typically aged 40-60 years) more frequently affected than men. In 20-30% of pSAC cases, the disease occurs bilaterally. It may resolve spontaneously within 2-4 years.

There is no consensus regarding the best treatment for pSAC, and many different types of conservative treatment and invasive procedures have been described.

CLINICAL EVIDENCE

Hussein and Donatelli, Eur J Physiother 2016;18:63-76.

The efficacy of radial extracorporeal shockwave therapy in shoulder adhesive capsulitis: a prospective, randomized, double-blind, placebo-controlled, clinical study

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TREATMENT PROTOCOL

Number of treatment sessions 3 to 5
Interval between two sessions 1 week
Air pressure Evo Blue® 2 to 4 bar
Air pressure Power+ 1.5 to 3 bar
Impulses 2,000 on the painful spot
Frequency 8Hz to 12Hz
Applicator 15 mm
Skin pressure Moderate to heavy

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