The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these clinical practice guidelines is to describe the peer-reviewed literature and make recommendations related to adhesive capsulitis.

J Orthop Sports Phys Ther 2013;43(5):A1-A31. doi:10.2519/jospt.2013.0302

KEY WORDS: clinical practice guidelines, frozen shoulder, ICD, ICF, Orthopaedic Section

STUDY DESIGN: Controlled laboratory study. OBJECTIVES: To determine the effect of the modified scapular assistance test (SAT) on 3-dimensional shoulder kinematics, strength, and linear measures of subacromial space in patients with subacromial impingement syndrome (SAIS). BACKGROUND: Abnormal scapular kinematics have been identified in patients with SAIS. Increased scapular upward rotation and posterior tilt, as induced with manual assistance using the SAT, have been theorized to increase subacromial space and may alter shoulder strength. METHODS: Forty-two subjects (21 with SAIS and 21 controls) participated in this study. The anterior outlet of the subacromial space, measured via the acromiohumeral distance on ultrasound images, and 3-dimensional scapular kinematics, measured using motion analysis, were determined with the arm at rest, and at 45° and 90° of active elevation with and without the SAT. A dynamometer was used to measure isometric shoulder strength. Full factorial mixed-model analyses of variance evaluated the effects of the SAT on variables between groups. RESULTS: There was an increase in scapular posterior tilt at all angles, upward rotation at rest and 45° of elevation, and acromiohumeral distance at 45° and at 90° with the SAT. The SAT did not alter normalized isometric strength. There were no differences in response to the SAT between the SAIS and control groups. CONCLUSIONS: Manual scapular assistance using the SAT influences factors associated with SAIS, such as subacromial space and potentially scapular orientation during static arm elevation, but not more so in individuals with SAIS than in healthy individuals. The SAT performed statically may be a way to identify potential subgroups of individuals with SAIS for whom subacromial space narrowing may be a contributing factor.

J Orthop Sports Phys Ther 2012;42(5):400-412, Epub 27 January 2012. doi:10.2519/jospt.2012.3579

KEY WORDS: acromiohumeral distance, examination, rotator cuff disease, shoulder, ultrasound imaging

STUDY DESIGN: Controlled laboratory study. OBJECTIVES: To examine the effects of altering posture on the subacromial space (SAS) in subjects with rotator cuff disease and subjects without shoulder pain. BACKGROUND: Poor upper quadrant posture has been linked to altered scapular mechanics, which has been theorized to excessively reduce SAS. However, no study has examined the direct effects of altering upper quadrant posture on SAS. We hypothesized that upright posture would increase and slouched posture would decrease the SAS, as compared to a normal posture, when measured both with the shoulder at rest along the side of the trunk and when maintained in 45° of active shoulder abduction. METHODS: Participants included 2 groups: the subjects with shoulder pain and rotator cuff disease, as diagnosed via magnetic resonance imaging (n = 31), and control subjects without shoulder pain (n = 29). The SAS was imaged with ultrasound using a 7.5-MHz linear transducer placed in the coronal plane over the posterior to midportion of the acromion. The SAS was measured on ultrasound images using the acromiohumeral distance (AHD), defined as the shortest distance between the acromion and the humerus. The AHD was measured in 2 trials at 2 arm angles (at rest along the trunk and at 45° of active abduction) and across 3 postures (normal, slouched, and upright), and averaged for data analysis. RESULTS: Two mixed-model analyses of variance, 1 for each arm angle, were used to compare AHD across postures and between groups. There was no interaction between group and posture, and no significant main effect of group for either arm position. There was no significant main effect of posture for the arm at rest (P = .26); however, there was a significant main effect of posture on AHD at the 45° abduction arm angle (P = .0002), with a significantly greater AHD in upright posture (mean AHD, 9.8 mm), ascompared to normal posture (mean AHD, 8.6 mm). CONCLUSION: The effect of posture on SAS, as measured by the 2-dimensional AHD using ultrasound of the posterior to middle aspect of the SAS, is small. The AHD increased with upright posture by 1.2 mm compared to normal posture, when the arm was in 45° active abduction.

J Orthop Sports Phys Ther 2010;40(10):633-640, Epub 6 August 2010. doi:10.2519/jospt.2010.3155

KEY WORDS: impingement, posture, rotator cuff, shoulder, subacromial space