Adhesive

Capsulitis
 INTRODUCTION
• Insidious condition characterized by painful
and progressive.
• Loss of active and passive range of motion of
glenohumeral joint in multiple planes.
• Occurs in 2% to 5% of adults in between age
40-70 years.
• Thyroid and diabetes patients are more
susceptible.
 Causes
Adhesive
capsulitis

Primary (if occur Secondary (occurs

without any after any trauma or
pathology) associate conditions)

Intrinsic to GH
Extrinsic to GH joint (Associated
Systemic (associates
joint (Associated with rotator cuff tear
with diabetes)
with humeral #) )
 Stages
1. Painful or Preadhesive stage

• Mild shoulder pain and Gh Rom decreased

• Full ROM achieved only in anesthesia
• Arthroscopic study indicate pathology most
sever in anterosuperior capsule
• Multiple nerve cells are present in the tissue
sample.
2.Freezing phase or acute(3-9)

• Fibroblastic proliferation seen in the joint capsule .

• Loss of ROM with or without anesthesia due to dense fibrotic
scar formation
• Increase of kinetics which increased fibroblast proliferation
and collagen synthesis.
• T and B cell found in the tissue sample
• Capsular fibrosis is the result of an initial inflammatory
process.
• High level of tissue inhibitors of metallo proteinases (TIMP)
have also been found in individual.
• Excessive collagen synthesis, remodeling of the collagen
matrix.