This APTA clinical practice guideline standardizes the diagnosis and physical therapy management of adhesive capsulitis using the WHO ICF framework. It synthesizes evidence on risk factors, staging, examination, and interventions. The central model matches treatment intensity to the patient's tissue irritability level.
When you see a 40-to-65-year-old with insidious shoulder pain and stiffness, the single most useful exam finding is passive external rotation loss with an intact rotator cuff. That pattern separates adhesive capsulitis from rotator cuff and impingement problems, which is critical because stage 1 disease mimics impingement before motion is lost.
The most practical concept for boards and clinic is the tissue irritability model. Match dosage to irritability, not to a fixed protocol: high irritability gets pain-relief and gentle motion, low irritability gets aggressive end-range stretching. Always screen for diabetes and thyroid disease, since diabetes raises risk about 5-fold and predicts a slower, worse recovery.
For treatment, the evidence rule is simple: intra-articular corticosteroid plus mobility/stretching gives the best short-term relief, but understand it front-loads recovery rather than changing the 6-to-12-month endpoint.
This APTA clinical practice guideline standardizes the diagnosis and physical therapy management of adhesive capsulitis using the WHO ICF framework. It synthesizes evidence on risk factors, staging, examination, and interventions. The central model matches treatment intensity to the patient's tissue irritability level.
When you see a 40-to-65-year-old with insidious shoulder pain and stiffness, the single most useful exam finding is passive external rotation loss with an intact rotator cuff. That pattern separates adhesive capsulitis from rotator cuff and impingement problems, which is critical because stage 1 disease mimics impingement before motion is lost.
The most practical concept for boards and clinic is the tissue irritability model. Match dosage to irritability, not to a fixed protocol: high irritability gets pain-relief and gentle motion, low irritability gets aggressive end-range stretching. Always screen for diabetes and thyroid disease, since diabetes raises risk about 5-fold and predicts a slower, worse recovery.
For treatment, the evidence rule is simple: intra-articular corticosteroid plus mobility/stretching gives the best short-term relief, but understand it front-loads recovery rather than changing the 6-to-12-month endpoint.