There are now four stages of AC. Stage 1- is characterized by a gradual onset of pain, typically referred tothe deltoid. It is usually achy at rest and sharper with movement. Pain common at night and an inability to sleep on the side. With an early loss of external rotation noticed.
Stage 2-represents the combination of acute synovitis and progressive capsular contracture, which some have called the freezing stage. Pain persists more at night, motion is restricted particular with forward flexion, abduction and external rotation.
Stage 3-is stage of maturation also as the frozen stage. Predominant complaint is significant stiffness. Pain persists at the end of range of movement occasional pain at night.
Stage 4-chronic stage also noticed or called the thawing stage. Pain is minimal with improvement in motion.
Effecive mgt includes patient education, soft tissue, myofascial release, STM to resore mobility As mobility improves introduction of joint mobilizations by the physiotherapist. Neuromuscular reeducation of posterior shoulder to provide stability, continued posterior capsule stretching, pecs are ideal. Strengthening scapular stabilizers such as low traps, rhomboids, ER are vital to unload the anterior shoulder.
Exercises to avoid based on science are shoudler press due to the increased axial load that could reproduce or reinstate a new inflammatory process, lat pulldowns because at end range the infraspinatus and teresminor or co contracting which places a great deal of stress onthe
superior, medial and inferior GH ligaments.
Ho, Cecilia, , C. et al, 2009, ‘the effectiveness of manual therapy in the management of musculoskeletal disorders of the shoudler:a systematic review,’ Journal of manual therapy, vol. 14, pp.463-479.
Jewell,D, & Riddle, D, 2009, Interventions associated with an increased or decreased risk likelihood of pain reduction and improved function in patients with adhesive capsulitis.’ a retospective study, Physical Therapy Journal, vol. 89, no 5, pp. 419-427.
Shah, N & Lewis, M, 2007, Shoudler adhesive capsulitis: Systematic review of randomized controlled trials using multiple corticosteroid injections. British Journal of General Practice, pp. 662-667.