Reviewed by Tyler Tice, PT, DPT, OCS, ATC


Shoulder Pain and Mobility Deficits: Adhesive Capsulitis Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health From the Orthopaedic Section of the American Physical Therapy Association J Orthop Sports Phys Ther 2013;43(5):A1-A31. doi:10.2519/jospt.2013.0302


The purpose of this clinical practice guideline (CPG) is to review the current best evidence regarding the treatment, and diagnosis of adhesive capsulitis for orthopedic physical therapists.  The goal of CPGs is to provide a reference for currently practicing clinicians and students to utilize when treating common orthopedic conditions.  The goal of this CPG is not to give a blueprint or exact protocol for treatment.  Evidence should always be viewed through the lens of clinical reasoning and patient care before it is utilized in a clinical setting. 


A group of content experts was chosen by the orthopedic academy of the American Physical Therapy Association (APTA) to describe the treatment and assessment of adhesive capsulitis using language consistent with he International Classification of Functioning, Disability and Health (ICF) model. 

              These content experts performed a literature review using CINHAL, MEDLINE and the Cochrane Database of Systematic Reviews.  Sources were collected from 1966 to 2011.  The selected sources were then ranked in order of quality and given grades I-V where I is considered as being of higher quality and V is considered as being expert opinion.  The experts then used the available evidence to create recommendations that were assigned grades A-F; A representing strong evidence and F representing expert opinion. 


The writers made recommendations regarding; pathoanatomical features, risk factors, clinical course, diagnosis/classification, differential diagnosis, imaging, outcome measures, activity limitations, physical impairment measures, and various treatment interventions. 

              For pathoanatomical features, a recommendation is to look for various range of motion impairments consistent with the capsular pattern of the glenohumeral joint, primarily a decrease in external rotation and abduction. 

              For risk factors, a recommendation is to look for diabetes mellitus or thyroid disease.  The condition is more prevalent in female patients aged 40-65 with a previous episode of adhesive capsulitis in the contralateral upper extremity. 

              Cor clinical course, it is recommended that clinicians consider that adhesive capsulitis occurs as a continuum of pathology with varying levels of pain, range of motion and functional limitations. 

For diagnosis/classification, clinicians should recognize that adhesive capsulitis presents as a gradual loss of function, passive range of motion and active range of motion that is often accompanied by pain. 

For examination and outcome measures, the authors recommend using validated outcome measures such as the SPADI and the DASH.  Activity limitation and participation restrictions should be determined based on the patient’s pain state and functional ability.  As for physical impairment measures, Active and passive range of motion and arthrokinematics motion are useful for predicting functional limitations. 

The treatment options with the highest level of evidence backing them are corticosteroid injections, patient education and stretching exercises.  Other less supported interventions include modalities, joint mobilization and translational manipulation. 

Discussion/Clinical Utility: 

This paper and CPGs in general are useful resources for clinicians and students.  As stated in the introduction, this CPG is not intended to make decisions for clinicians, but rather to serve as a reference and snapshot into what the research has been saying. 

              This CPG is useful because it lays out a great guideline for treatment, so clinicians have a starting point for planning treatment sessions.  It was especially helpful to have treatment recommendations based on the stage of this pathology and level of tissue irritability.  Being able to assess patients and determine their pain/irritability state is an important step in determining the most appropriate course of treatment so that we can provide the best care and optimize results.


Shoulder Pain and Mobility Deficits: Adhesive Capsulitis
Martin J. Kelley, Michael A. Shaffer, John E. Kuhn, Lori A. Michener, Amee L. Seitz, Tim L. Uhl, Joseph J. Godges, and Philip McClure.  Journal of Orthopaedic & Sports Physical Therapy 2013 43:5, A1-A31