Assess & Address: Frozen Shoulder by Whitney Lowe

Pathology Assessment & Evaluation Treatment Massage Techniques

Assessment and evaluation
Adhesive capsulitis is commonly evaluated through client history and physical examination. The condition affects women more often than men, and occurs more frequently in women age 45-65. A detailed client history is important to establish any characteristic patterns that indicate either a primary or secondary capsulitis. The most prominent symptoms are pain and loss of range of motion. Dysfunctional biomechanics and motion compensations. This image shows a client attempting to abduct the shoulder, with its motion limited by the adhered capsule.

An important approach to distinguishing adhesive capsulitis from similar shoulder problems is to evaluate the way in which motion is restricted at the shoulder joint. Most synovial joints of the body are enclosed in a joint capsule. When there is pathology, there is a characteristic pattern to the range-of-motion limitation in that joint. The pattern of limitation is unique to each joint. In the glenohumeral joint, the capsular pattern is for motion to be limited first in external rotation, then in abduction, and finally in medial rotation.

To understand how to apply the concept of the capsular pattern, let’s look at a common shoulder complaint where the client has trouble bringing the arm up in abduction (above figure). A person with this motion restriction could have adhesive capsulitis; however, the client has no problem externally rotating the shoulder from a neutral position with the arm at the side. Because the capsular pattern indicates that motion restriction will first be observed in external rotation, it is unlikely this person has a capsular pathology.

However, other conditions, such as sub-acromial impingement, calcific tendonitis or bursitis, are all likely to produce restriction in abduction. Assuming this problem to be adhesive capsulitis can lead to faulty methods of addressing the problem. This underscores the importance of a thorough assessment.

In addition to active and passive range-of-motion evaluations, a special orthopedic test for measuring functional range of motion in the shoulder, called the Apley scratch test (see Figure 2), is useful. In this procedure, the shoulder of the arm being held overhead is in abduction and external rotation while the shoulder of the lowered arm is in adduction and internal rotation (with a slight degree of extension). You should have the client perform this test with both sides in the upper and lower positions to compare the available range on each side.

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