Shoulder CPG

"Intra-articular corticosteroid injections combined with shoulder mobility and stretching exercises are more effective in providing short-term (4–6 weeks) pain relief and improved function compared to shoulder mobility and stretching exercises alone."

• Level A

• Level B

• Level C

• Level D

"Clinicians should consider diagnostic classifications other than adhesive capsulitis when the patient's reported activity limitations or impairments of body function and structure are not consistent with the diagnosis/classification section of these guidelines, or when the patient's symptoms are not resolving with interventions aimed at normalization of the patient's impairments of body function."

• Level C

• Level D

• Level E

• Level F

"Clinicians should utilize patient education that (1) describes the natural course of the disease, (2) promotes activity modification to encourage functional, pain-free ROM, and (3) matches the intensity of stretching to the patient's current level of irritability."

• Level A

• Level B

• Level C

• Level D

"Clinicians should use validated functional outcome measures, such as the DASH, the ASES, or the SPADI. These should be utilized before and after interventions intended to alleviate the impairments of body function and structure, activity limitations, and participation restrictions associated with adhesive capsulitis."

• Level A

• Level B

• Level C

• Level D

"Clinicians may utilize joint mobilization procedures primarily directed to the glenohumeral joint to reduce pain and increase motion and function in patients with adhesive capsulitis."

• Level A

• Level B

• Level C

• Level D

"Clinicians should instruct patients with adhesive capsulitis in stretching exercises. The intensity of the exercises should be determined by the patient's tissue irritability level."

• Level A

• Level B

• Level C

• Level D

"Clinicians may utilize shortwave diathermy, ultrasound, or electrical stimulation combined with mobility and stretching exercises to reduce pain and improve shoulder ROM in patients with adhesive capsulitis."

• Level B

• Level C

• Level D

• Level E

"Clinicians should measure pain, active shoulder ROM, and passive shoulder ROM to assess the key impairments of body function and body structures in patients with adhesive capsulitis. Glenohumeral joint accessory motion may be assessed to determine translational glide loss."

• Level B

• Level C

• Level D

• Level E

"Clinicians should assess for impairments in the capsuloligamentous complex and musculotendinous structures surrounding the shoulder complex when a patient presents with shoulder pain and mobility deficits (adhesive capsulitis). The loss of passive motion in multiple planes, particularly external rotation with the arm at the side and in varying degrees of shoulder abduction, is a significant finding that can be used to guide treatment planning."

• Level B

• Level C

• Level D

• Level E

"Clinicians should recognize that (1) patients with diabetes mellitus and thyroid disease are at risk for developing adhesive capsulitis, and (2) adhesive capsulitis is more prevalent in individuals who are 40 to 65 years of age, female, and have had a previous episode of adhesive capsulitis in the contralateral arm."

• Level C

• Level D

• Level E

• Level F