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Classification of Adhesive Capsulitis

David Nolan, PT, DPT, MS, OCS, SCS, CSCS

March 1, 2017

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Question

Can you explain the differences between primary and secondary adhesive capsulitis?  

Answer

Primary adhesive capsulitis is defined as a diagnosis for all cases which the underlying etiology or associated condition cannot be identified. In other words, the patients that come in that really have no mechanism or no pre-disposing event that happened, truly an insidious onset. Most literature reports the vast majority of patients presenting with adhesive capsulitis fall into this primary category. Secondary adhesive capsulitis is going to include all cases of frozen shoulder in which there's an underling etiology or associated condition that can be identified. So really our patients' subjective history becomes very important.  The secondary category can be broken down a little bit further into three more sub-categories: Intrinsic, extrinsic, and systemic. Intrinsic adhesive capsulitis is something that's happening in association with something inside the shoulder, such as rotator cuff, biceps tendinitis, calcific tendinitis.  So there is something going wrong in the shoulder that's now gonna create a problem. Somebody that has a rotator cuff impingement or tear, biceps tendon problem or calcific tendinitis presents with shoulder pain so they will not move it which results in some stiffness. With extrinsic, there's an identifiable abnormality remote to the shoulder itself, but in the same neighborhood. For example, people that have had mastectomy, cervical radiculopathy, a stroke or heart attack, humeral fracture, or AC arthritis is going to impact the soft tissues surrounding the area, may create the need for immobilization, whether it is intended like with a fracture or just for comfort, then start to develop some stiffness. The systemic component within secondary frozen shoulder is associated with systemic disorders such as diabetes, thyroid conditions and then hypoadrenalism. 


david nolan

David Nolan, PT, DPT, MS, OCS, SCS, CSCS

Dr. Nolan is an Associate Clinical Professor at Northeastern University in the Department of Physical Therapy, Movement and Rehabilitation Sciences as well as a Graduate Lecturer in the College of Professional Studies in the transitional Doctor of Physical Therapy Program at Northeastern University.  David is also a Clinical Specialist at the Mass General Sports Physical Therapy Service and the Director of the MGH / Northeastern University Sports Physical Therapy Residency Program. 

Dr. Nolan is a board certified Orthopedic Clinical Specialist and Sports Clinical Specialist through the American Board of Physical Therapy Specialties and a Certified Strength and Conditioning Specialist through the National Strength and Conditioning Association.  He is a past recipient of the “Excellence in Clinical Teaching” award from the New England Consortium of Academic Coordinators of Clinical Education as well as the award for Outstanding Achievement in Clinical Practice by the Massachusetts Chapter of the APTA.  Dr. Nolan was also presented with the 2019 Lynn Wallace Clinical Educator award from the American Academy of Sports Physical Therapy. 


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Adhesive Capsulitis is characterized by a painful, gradual loss of motion which may lead to significant functional limitations. This session will review the epidemiology, classification, and differential diagnosis associated with adhesive Capsulitis. Current evidence related to conservative rehabilitation management utilizing exercise and joint mobilization will also be reviewed. This course is directly related to the practice of physical therapy and athletic training and is appropriate for the PT, PTA and AT.

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