1. Speed’s Test Bicipital Tendonitis

2. Drop Arm Test Supraspinatus Involvement

3. Empty/Full Can Test Supraspinatus Involvement

4. External Rotation Lag Sign (ERLS) Infraspinatus Involvement

5. Lift Off Test Lift Off Test Subscapularis Involvement

6. Adhesive Capsulitis “A pathologic continuum initiated by synovial inflammation with resultant capsular fibrosis” It’s Inflammatory & Fibrosing

7. Adhesive Capsulitis Patient Profile: Females > Males Females > Males > 40 years of age > 40 years of age Correlated with DM Correlated with DM Associated with Thyroid and Autoimmune Diseases Associated with Thyroid and Autoimmune Diseases Associated with CVA and MI Associated with CVA and MI History of prolonged immobilization History of prolonged immobilization

8. Adhesive Capsulitis 4 Stages Include: (1 – 3 years) 1 - First 3 months, pain limits rom 1 - First 3 months, pain limits rom 2 - The “freezing” Phase, months 3 - 9 2 - The “freezing” Phase, months 3 - 9 3 - The “frozen” Phase, months 9 -14 3 - The “frozen” Phase, months 9 -14 4 - The “Thawing” Phase, after month 14 4 - The “Thawing” Phase, after month 14Types Primary – idiopathic Primary – idiopathic Secondary – Acquired from a known cause Secondary – Acquired from a known cause

9. Adhesive Capsulitis Treatment Treatment Medication for pain Medication for pain Positioning for comfort Positioning for comfort Education about the disease process Education about the disease process Gentle rom exercise in the early stages within established pain parameters Gentle rom exercise in the early stages within established pain parameters Reassure, Reassure & Reassure Reassure, Reassure & Reassure

10. Considerations For Referral Traumatic vs. Insidious Traumatic vs. Insidious Acute vs. Chronic Acute vs. Chronic Patient’s Age & Activity Level Patient’s Age & Activity Level Acromion Type Acromion Type Structural Deformity Structural Deformity Severity of Limitations Severity of Limitations Patient’s Overall Health Patient’s Overall Health Compliance History (In LCR) Compliance History (In LCR)

11. Physical Therapy Considerations What is the movement system diagnosis (independent of the pathophysiologic diagnosis)? What is the movement system diagnosis (independent of the pathophysiologic diagnosis)? Are there movement abnormalities that are correctable? Are there movement abnormalities that are correctable? What corrective exercise/postural re- education would benefit this patient? What corrective exercise/postural re- education would benefit this patient? Compensatory strategies? Compensatory strategies? Is this patient compliant? Is this patient compliant?

12. Bibiliography 1.Davies, George J., Wilk, Kevin, Ellenbecker, Todd, Et Al., Current Concepts of Orthopaedic Physical Therapy, 2 nd Edition, The Shoulder: Physical Therapy Patient Management Utilizing Current Evidence. APTA, Orthopaedic Section, 2006. 2.Magee, David J., Orthopedic Physical Assessment, Fourth Edition. Philadelphia, Saunders, 2002. 3.Neumann, Donald A., Kinesiology of the Musculoskeletal System, Foundations for Physical Rehabilitation. St. Louis, Mosby, 2002. 4.Sahrmann S. Diagnosis and Treatment of Movement Impairment Syndromes. St. Louis, Mosby, 2002.