New York State Medical Treatment Guidelines for
Adhesive Capsulitis / Frozen Shoulder Disorder
in workers compensation patients

The New York State workers compensation board has developed these guidelines to help physicians, podiatrists, and other healthcare professionals provide appropriate treatment for Adhesive Capsulitis / Frozen Shoulder Disorder.

These Workers Compensation Board guidelines are intended to assist healthcare professionals in making decisions regarding the appropriate level of care for their patients with ankle and foot disorders. The guidelines are not a substitute for clinical judgement or professional experience. The ultimate decision regarding care must be made by the patient in consultation with his or her healthcare provider.

Adhesive Capsulitis / Frozen Shoulder

Adhesive Capsulitis is a soft tissue disease of the shoulder that affects the glenohumeral and scapulothoracic joints and limits passive and active range of motion is known as adhesive capsulitis of the shoulder, commonly known as frozen shoulder problem.

Any chest or upper extremities trauma results in the secondary development of occupational adhesive capsulitis. Among other etiologies, it may also happen after a stroke, traumatic brain damage, or spinal cord injury. Rarely is primary adhesive capsulitis caused by a job. The condition progresses via the following stages:

Stage 1: includes intense pain and some range of motion restriction; typically lasts two to nine months. glenohumeral to scapulothoracic mobility is lost by the anticipated 2:1 degrees.

Stage 2: It may continue for a further four to twelve months after Stage 1 and is characterised by increased stiffness, loss of range of motion, and muscle atrophy.

Stage 3: It typically requires an additional six to nine months after Stage 2 and is characterised by partial or complete symptom remission as well as the return of strength and range of motion.

History and Mechanism of Injury for Adhesive Capsulitis / Frozen Shoulder Disorder

• Mechanism of Injury: The shoulder, shoulder tendon, labrum ligament, or other tissue frequently has a history of prior damage. Refer to the appropriate area of this Guideline for more information. Adhesive capsulitis is frequently encountered along with impingement syndrome or other shoulder diseases.
• The patient will typically report pain in the sub-deltoid area, but it may also radiate over the long head of the biceps or down the side of the arm to the forearm. Pain frequently gets greater at night, making it difficult to sleep on the affected side. Motion is painfully limited.

Physical Findings of Adhesive Capsulitis / Frozen Shoulder Disorder

Shoulder Injury: Restricted Active and Passive Glenohumeral and Scapulothoracic NYS WCB MTG The main physical finding is 21 range of motion. To rule out other shoulder disorders, it may be helpful for the examiner to inject lidocaine into the glenohumeral joint. A subsequent range-of-motion test should be repeated; if there is no improvement, the diagnosis is confirmed. Deltoid and supraspinatus muscle atrophy, postural alterations, and secondary trigger sites may all be present.

Laboratory Tests of Adhesive Capsulitis / Frozen Shoulder Disorder

Laboratory Tests of Adhesive Capsulitis / Frozen Shoulder Disorder are recommended When a systemic illness or disease is suspected in a subset of patients.

Testing Procedures X-Ray of Adhesive Capsulitis / Frozen Shoulder Disorder X-Ray or MRI

Testing Procedures X-Ray of Adhesive Capsulitis / Frozen Shoulder Disorder X-Ray or MRI are recommended when there is at least a relatively high index of suspicion of another underlying pathology, in a subset of patients as clinically indicated to rule out concomitant pathology, either in acute injury or with injuries that have not responded/progressed with nonoperative care.

Arthrography of Adhesive Capsulitis / Frozen Shoulder Disorder

Arthrography of Adhesive Capsulitis / Frozen Shoulder Disorder are recommended in a few cases when clinically necessary.

Indications: When other pathology is suspected, this information may be useful for excluding it or for identifying and diagnosing a constricted joint capsule. Arthrography can also be therapeutic because it allows for the simultaneous injection of anaesthetics, steroids, and/or both (for more information, see the following section on non-operative therapy options).

Non-Operative Treatment Procedures

Alternative Medicine The following procedures could be used to restore and sustain function:

• The mainstay of treatment is physical medicine, which may involve heat therapy, ultrasound, TENS, manual therapy, and passive and active range-of-motion exercises. As the patient improves, strengthening activities are added. The fitness programme should consist of 22 exercises.
• Narcotics should only be used in post-operative or post-manipulative cases; medications like NSAIDs and analgesics may be useful in other situations.

Subacromial or Intra-articular space injection with steroids

Subacromial or Intra-articular space injection with steroids are recommended in a few cases when clinically necessary.

Indications: In some cases, steroid injections into the glenohumeral, subacromial bursa, or intra-articular region can reduce inflammation and enable the therapist to increase functional activity and range of motion.

If the patient responded favourably to a diagnostic injection of an anaesthetic, subacromial space injection with steroids might be helpful. Direct steroid injections into the tendons are not advised.

Frequency: In most cases, one or two injections are sufficient. It is advised to wait at least three weeks between injections. Local anaesthetics take immediate impact, but corticosteroids take three days to start working. Maximum duration: Three injections at the same place per year is the maximum allowed.

Distension Arthrography or “Brisement”

Distension Arthrography or “Brisement” are recommended – in a few cases when clinically necessary.

Indications: Distension arthrography or “brisement,” in which saline, anaesthetic, and typically a steroid are forcefully injected into the shoulder joint to disrupt the capsule, may be considered in cases that are resistant to conservative therapy lasting at least three to six months and where range of motion remains significantly restricted (abduction less than 90).

Distension arthrography or manipulation under anaesthesia (MUA) should be followed by early and intensive physical therapy to maintain range of motion and restore strength and function; Within one week of the treatment, a return to work with limitations is to be anticipated; four to six weeks later, a return to full duty.

Manipulation of Adhesive Capsulitis / Frozen Shoulder Disorder

Manipulation of Adhesive Capsulitis / Frozen Shoulder Disorder are recommended in a few cases when clinically necessary.

Frequency: Depending on the level of involvement and the intended result, up to twice a week for eight to twelve weeks, followed by two treatments a week for the following four weeks.

Optimum duration: Eight to 12 weeks.

Maximum duration: Thirty days. In cases of intractable adhesions or when activity is resumed following intra-articular injection, an arthrogram, or manipulation under anaesthesia (performed by a trained surgeon), longer care periods than what is deemed “maximum” may be required. For shoulder treatment, it can take one to six sessions to see results.

Operative Procedures Manipulation Under General Anaesthesia (MUA)

Operative Procedures Manipulation Under General Anaesthesia (MUA) are recommended – in a few cases when clinically necessary.

Indications: For cases with considerable range of motion limitations (abduction less than 90) and those who have failed conservative therapy for at least three to six months.

In cases of unreachable restriction, manipulation under general anaesthesia (MUA) may be indicated and carried out by a doctor or surgeon who is duly qualified. It may be carried out in conjunction with steroid injection or arthrography that causes distension.

Post-Operative Procedures

Post-Operative Procedures are recommended in a few cases when clinically necessary.

Note: To maintain range of motion and advance strengthening, early and aggressive physical medicine interventions are advised; return to work with restrictions following surgery should be negotiated with the treating clinician.

Within 8 to 12 weeks after surgery, the patient should be approaching MMI; however, the coexistence of concomitant pathology should be taken into account.

What our office can do if you have Adhesive Capsulitis / Frozen Shoulder Disorder

We have the experience to help you with their workers compensation injuries. We understand what you are going through and will meet your medical needs and follow the guidelines set by the New York State Workers Compensation Board.

We understand the importance of your workers compensation cases. Let us help you navigate through the maze of dealing with the workers compensation insurance company and your employer.

We understand that this is a stressful time for you and your family. If you would like to schedule an appointment, please contact us so we will do everything we can to make it as easy on you as possible.