1. MANAGEMENT OF
ADHESIVE CAPSULITIS:
- a evidence informed practice
By
K .H.Dhiwahar .MPT(SPORTS)

2. OBJECTIVES
To know about evidence on
management for adhesive capsulitis.

3. INTRODUCTION
Adhesive capsulitis is a painful condition
in which movement of the shoulder
becomes severely restricted. The
condition can vary in severity from mild
to severe pain and/or from some to severe
restriction in movement
.

4. SYSTEMATIC REVIEW
 A review of the evidence on a clearly formulated question that uses
systematic and explicit methods to identify, select and critically appraise
relevant primary research, and to extract and analyze data
from the studies that are included in the
review.”
Cochrane Collaboration

5. HIERARCHY OF THE EVIDENCE

6. Formulating review questions
 The first and most important decision in preparing a
review is to determine its focus.
 This is best done by asking clearly framed questions.

7. CLINICAL QUESTION
Problem: In the patient with adhesive capsulitis
will the conservative management will help to
reduce pain ,increase ROM and physical function
Intervention:corticosteroid injections, patient
education ,modalities, joint mobilization
,translational manipulation ,stretching exercises
Comparison: any of the above
Outcomes: pain, ROM and physical function

8. SEARCH STATERGY
The systematic reviews were
searched from three electronic
Database, COCHRANE, PUBMED
and PEDRO

9. WHAT I FOUND IS
Shoulder Pain and Mobility Deficits: Adhesive
Capsulitis
Clinical Practice Guidelines Linked to the
International Classification of Functioning,
Disability, and Health From the Orthopedic
Section of the American Physical Therapy
Association
J Orthop Sports Phys Ther 2013;43(5):A1-A31.
doi:10.2519/jospt.2013.0302
- MARTIN J. KELLEY, DPT AND et al

10. GRADES OF EVIDENCE
a4 | may 2013 | volume 43 | number 5 | journal of orthopedic
& sports physical therapy . MARTIN J. KELLEY, DPT AND et al

11. LEVEL OF EVIDENCE
a4 | may 2013 | volume 43 | number 5 | journal of
orthopedic & sports physical therapy . MARTIN J. KELLEY, DPT
AND et al

12. INTERVENTION
 CORTICOSTEROID INJECTIONS
 MODALITIES
 JOINT MOBILIZATION
 TRANSLATIONAL MANIPULATION
 STRETCHING EXERCISES
 PATIENT EDUCATION

13. CORTICOSTEROID INJECTIONS
Author Type of
study & n
Inclusion criteria Outcome measure Level of
evidence
Carette et al RCT
N = 93
>1yr
LIMITED AROM & PROM >25%
ROM.SPADI,SF-36 I
Ryans et al
RCT
N=80
PAIN IN 5TH CERVICAL
DERMATOME >4WKS,<6MO
LIMITED AROM & PROM >25%
SDQ,A&PROM,
VAS
FUNCTIONAL
DISABLITY Q
I
Arslan and
Çeliker
RCT
N=20
<50%OF NORMAL MO ROM ,VAS II
De Jong etal RCT
N=32
<45*EXT ROT,DIST OF SLEEP
ON LYING POSITON
DIST OF SLEEP
,ROM,VAS
II
Jacobs etal RCT
N=53
NOT CLEARLY DEFINED VAS, SF-36 I

14. CORTICOSTEROID INJECTIONS
Author Type of
study &
n
Inclusion criteria Outcome
measure
Level of
evidence
bass &
collegues
rct limited arom & prom >25% vas
sf-36
II
- rct
n=71
limit of arom,prom,abd,flx
<100*,ext ,int rot <20*
vas
rom
constant score
I
LORBACH ET
AL
rct
n=25
stage 2 reeevs classifaction rom,
ases,
constant score
IV
blanchard et al Rct
N=6
- - I
bulgen et al
RCT
N=41
Pain in shouldr @ least 1mo,
Sleep disturbance at night
due to pain, inability to lie on
the afft shoulder, limit in all
arom,prom & a red in ext rot
aleast 50%.
II

16. PATIENT EDUCATION
Author Type of
study & n
Inclusion
criteria
Outcome
measure
Level of
evidence
DIEWRCKS &
STEVENS
RCT
N=77
>50% ROM REST
GHJ,PERIOD OF
3 MO
CONSTANT
SCORE
I

18. MODALITIES
Author Type of
study &
n
Inclusion criteria Outcome measure Level of
evidence
DOGRU et al RCT
N=49
MIN 3MO,>25%REST
MOVT IN ALL PLANES
SF-36
SPADI
ROM
II
Mao et al
RCT
N=12
H/O PAIN,STIF
NESS,>MO,REST<140*FL
EX,120*ABD,70*INT
ROT,50*EXT ROT
- IV
Guler-Uysal
and
Kozanoglu
RCT
N=42
LOSS AROM.PROM
SH.PAIN MIN 2MO,
ROM II
LEUNG &
CHEING
RCT
N=30
IDOPATHI PAIN,
LOSS AROM PROM FOR
8WK
ASES,
ROM
II
CHEING AND
COLLEAGUES
RCT
N=70 PAIN IN SHOULDER,
NIGHT PAIN, AND
RESTR AROM PROM
CONSTANT-
MURLEY
ASSESSMENT
II

20. JOINT MOBILIZATION
Author Type of
study &
n
Inclusion
criteria
Outcome
measure
Level of
evidence
Vewrmeulan
ewt al
RCT
N=100
Unilat.AC,50%loss
PROM in 1 or
more plane for
3mo
SDQ,SHOULDWE
R RATING Q,SF-
36,ROM,VAS
II
Nicholson RCT
N=20
Shoulder pain,
limit PROM
ROM II
Chen &
colleagues
RCT
N=78
unilat.ac,<140*fle
x,abd rom,>10cm
hand behind
neck
VAS,ROM II
Bulgen et al RCT
N=41
Pain in shouldr @
least 1mo,
Sleep
disturbance at
night due to pain,
inability to lie on
the afft shoulder,
ROM,VAS II

21. JOINT MOBILIZATION
Author Type of
study &
n
Inclusion criteria Outcome
measure
Level of
evidence
Vermeulen
et al
RCT
N=9
STIFF SHOULDER
3MO,50%RST
ABD,FLEX
ROM IV
Yang &
collwegues
RCT
N=28
PAIN
3MO,25%RST
ROM
ROM IV
Tanaka et
al
RCT
N=110
LIMIT SHOULDER
MOTION
ROM II
Johnson et
al
RCT
N=20
EXT ROT, ABD
RST
VAS,5-ITEM
SELF
ASSESMENT
FUNCTION
Q,ROM
II

23. TRANSLATIONAL MANIPULATION
Author Type of
study &
n
Inclusion criteria Outcome
measure
Level of
evidence
Roubal et
al
RCT
N=8
NOT
SPECIFIED
ROM IV
Placzek et
al
RCT
N=31
DEC
FUNCTION,PAI
NFUL AROM
PROM
VAS
,WOLFGAN
G SCALE
IV

25. STRETCHING EXERCISES
Author Type of
study & n
Inclusion criteria Outcome
measure
Level of
evidence
Kivimaki et
al
RCT
N=125
PAIN,<140*ELV,<
30*EXT.ROT.
ROM,SDQ II
Diercks &
stevens
RCT
N=77
50%RST GHJ,IN
ALL DIRT FOR
3MO
CONSTANT
SCORE
II
Griggs et al RCT
N=75
STAGE 2
IDOPATHI AC
SST,DASH,RO
M,VAS,SF-36
II
Lee et al RCT
N=65
NOT SPECIFIED ROM II
- RCT
N=28
50% RST EXT
ROT,ABD,FLX
MODFIED
CONSTANT
SCORE
,VAS,ROM
II
Levine ewt IV

27. CONCLUSION

29. REFERENCE
 1.American Physical Therapy Association. Guide
to physical therapist practice. Second edition.
Phys Ther. 2001;81:9-746.
 a4 | may 2013 | volume 43 | number 5 | journal of
orthopedic & sports physical therapy . MARTIN
J. KELLEY, DPT AND et al