SYNOPSIS: Frozen shoulder or adhesive capsulitis describes the common shoulder condition characterized by painful and limited active and passive range of motion. The etiology of frozen shoulder remains unclear; however, patients typically demonstrate a characteristic history, clinical presentation, and recovery. A classification schema is described, in which primary frozen shoulder and idiopathic adhesive capsulitis are considered identical and not associated with a systemic condition or history of injury. Secondary frozen shoulder is defined by 3 subcategories: systemic, extrinsic, and intrinsic. We also propose another classification system based on the patient’s irritability level (low, moderate, and high), that we believe is helpful when making clinical decisions regarding rehabilitation intervention. Nonoperative interventions include patient education, modalities, stretching exercises, joint mobilization, and corticosteroid injections. Glenohumeral intra-articular corticosteroid injections, exercise, and joint mobilization all result in improved short- and long-term outcomes. However, there is strong evidence that glenohumeral intra-articular corticosteroid injections have a significantly greater 4- to 6-week beneficial effect compared to other forms of treatment. A rehabilitation model based on evidence and intervention strategies matched with irritability levels is proposed. Exercise and manual techniques are progressed as the patient’s irritability reduces. Response to treatment is based on significant pain relief, improved satisfaction, and return of functional motion. Patients who do not respond or worsen should be referred for an intra-articular corticosteroid injection. Patients who have recalcitrant symptoms and disabling pain may respond to either standard or translational manipulation under anesthesia or arthroscopic release. LEVEL OF EVIDENCE: Level 5.

J Orthop Sports Phys Ther. 2009;39(2):135-148. doi: 10.2519/jospt.2009.2916

KEY WORDS: adhesive capsulitis, corticosteroid injection, glenohumeral joint, joint mobilization

STUDY DESIGN: Retrospective case series. BACKGROUND: Spinal accessory nerve palsy (SANP) is common following neck dissection surgery and can occur with blunt or penetrating trauma to the lateral neck region and cervical stretch injuries. Early detection of SANP remains a clinical challenge and the condition is often misdiagnosed. The purpose of this case series is to describe the associated history, signs, and symptoms related to SANP and increase awareness of the scapular flip sign as a clinical sign associated with SANP. CASE SERIES DESCRIPTION: Twenty subjects (13 male, 7 female) presented with pain and decreased shoulder function following head and neck surgery or posttrauma. All patients were thoroughly examined and the scapular flip sign was assessed. All patients presented with a cluster of signs and symptoms including trapezius atrophy, shoulder girdle depression, limited active shoulder abduction to less than 90°, shoulder pain, and shoulder weakness. A positive scapular flip sign was present in all cases. The middle and lower trapezius were rated as 0/5, based on manual muscle testing, indicating no identifiable muscle activation against resistance. DISCUSSION: A typical history and consistent signs and symptoms were found related to SANP. A strong relationship appeared between the presence of the scapular flip sign and SANP. The suspected mechanism for the scapular flip sign is the unopposed pull of the humeral external rotators by the inactive middle and lower trapezius. Early identification of SANP can assist with the prognosis, explain persistent impairments and functional deficits, motivate appropriate diagnostic testing and interventions, and help maximize outcome. Further research to validate the scapular flip sign and establish a clinical prediction rule for the diagnosis of SANP should be performed. LEVEL OF EVIDENCE: Diagnosis, Level 4.

J Orthop Sports Phys Ther. 2008;38(2):78-86, published online 7 September 2007. doi:10.2519/jospt.2008.2454

KEY WORDS: examination, neck, shoulder, trapezius

Quantitative measurement of the shoulder abductors is important in a comprehensive assessment of shoulder muscle performance. Testing in traditionally accepted positions may be compromising to the glenohumeral static and dynamic stabilizers; therefore, there is a need to investigate testing in other planes of motion. The purpose of this study was to compare torque produced during isokinetic testing of shoulder abduction in the coronal plane and the scapular plane. Twenty female subjects with no previous shoulder pathology were tested at 90°/sec and 210°/sec in the coronal and scapular planes using the Cybex II isokinetic dynamometer. Both peak torque and mean peak torque of three trials were recorded. A t test for related samples (p < .05) revealed no significant difference in the peak and mean peak torque produced at each speed. Using a two-way analysis of variance with repeated measures, no significant difference was bund in the peak torque produced between the two planes. However, torque production at 90°/sec in both test positions was significantly higher than torque production at 210°/sec (F1,19 = 159.610, p < .001). Although anatomical, functional, and clinical reasons have been proposed for performing exercise and testing procedures of the shoulder abductors in the scapular plane, the results of this study indicate that in healthy young women, there is no difference in torque production between the two planes.

J Orthop Sports Phys Ther. 1995;21(4):227-232.

Key Words: muscle strength, shoulder, dynamic