The
patient presentation varies depending on
the stage at which the patient presents.
The patient is usually over 40 years of
age. In the acute phase, the patient complains
of moderate to severe pain that limits all
shoulder movements. In most cases, the patient
cannot recall any specific event that triggered
the pain. The pain interferes with sleep,
and in many cases causes the patient to
seek prescribed pain medication. In the
middle phase, the patient may present with
a past history of the acute phase one to
three months previously; now the pain is
much less, but he or she notices that lifting
the arm or turning it out is severely restricted.
In the final phase, the patient may report
a very slow increase in range of motion,
but there is still significant reduction.
Cause:
The
cause is unknown. The accepted theory is
that adhesion development occurs between
or within the capsule of the shoulder, however
this is not always visable at surgery.
Evaluation:
Most
patients present in the stiffening phase.
The classic restriction pattern is a significant
and equal loss of active and passive range
of motion. The movements most affected are
abduction and external rotation.
Treatment:
Treatment
focuses on pain relief using physical therapy
methods while in office. Several home exercises
are available for at home treatments.
