Adhesive capsulitis is also called arthrofibrosis, which involves excessive adhesion
formation along the glenohumeral joint. It is a disease of unknown etiology and is
classified as primary and secondary. Primary adhesive capsulitis includes cases of
idiopathic origin resulting from chronic inflammation with fibroblast proliferation.
Secondary adhesive capsulitis, central nervous system involvement, arm immobilized for a
long time, trauma or fracture, infectious diseases, etc. Includes post-mortem situations.
It is characterized by shoulder pain, decreased range of motion, and limitation of
function. This affects the function of the entire upper extremity. Idiopathic adhesive
capsulitis usually involves the non-dominant upper extremity, with bilateral involvement
in 40-50% of cases. It is more common in women between the ages of 40 and 60. The
incidence of adhesive capsulitis among the population is between 3% and 5%. It has been
reported with up to 20% higher incidence in the diabetic population. It is also
associated with other pathological disorders such as thyroid dysfunction, coronary artery
disease and cerebrovascular disease. Although the pathology is self-limiting, long-term
symptoms develop in approximately 20% to 50% of cases.
Adhesive capsulitis progression is characterized by four stages, each stage presenting a
distinctive clinical picture.
The painful phase lasts less than three months and presents with shoulder pain at
night when glenohumeral movement is preserved.
The freezing process lasts three to nine months and is manifested by severe pain and
stiffness in the glenohumeral joint.
The frozen shoulder process lasts nine to fourteen months and is eventually
characterized by loss of motion and pain in all directions.
The resolution phase lasts for fifteen to twenty-four months and is characterized by
persistent stiffness, minimal pain, and delayed improvement in shoulder motion.
Abnormal shoulder kinematics develops in response to the lack of extensibility of the
capsule with the change in motor patterns in the central nervous system. Increased
thoracic kyphosis can be seen as postural deviations. However, fibrotic changes are also
seen in the periarticular connective tissue and trigger points. This presents as a higher
level of disability with painful shoulder. Physiotherapy is the mainstay of treatment for
patients with adhesive capsulitis. Joint mobilization has a proven role in conjunction
with Codman's exercises. Transcutaneous Electrical Nerve Stimulation (TENS), Diathermy is
used in the treatment to reduce pain. Instrument Assisted Soft Tissue Mobilization
(IASTM) is a soft tissue mobilization method that works by generating localized
inflammation and facilitates collagen synthesis and realignment. In fact, when IASTM is
given to soft tissues with appropriate pressure, localized inflammation occurs with
microvascular bleeding. This will increase blood flow to the injured area along with the
recruitment of more fibroblasts. With the removal of scar tissues and adhesions, healing
will be supported by the organization of collagen of fibroblasts. The fibronectin induced
by IASTM is required for tissue repair. A localized force will be transmitted through an
instrument to the affected tissues to leave a scar.
IASTM has become increasingly popular as a tool for the rehabilitation of sports
injuries. It has been proven to be successful in a short time in reducing pain and
increasing mobility after sports injuries. There are studies showing an increase in ROM
after a single application of this technique.
It is known that it takes a long time to relieve pain and achieve a good improvement in
ROM in adhesive capsulitis. This affects their quality of life and creates the need for
treatment options that provide a shorter recovery time. Various conservative protocols
are followed with physical therapy as the main treatment in adhesive capsulitis. Few
studies have used IASTM as a treatment to evaluate its effect on adhesive capsulitis.