Patients are assessed based on characterizations listed below and then identified as high, moderate, or low irritability. It is understood that all patients may not go through all three levels of intervention, for example, patient may already be in moderate or low irritability classification at the time of initial evaluation, but patient may certainly move from classification to another.
Characterized by:

Reports high levels of pain (7/10)

Consistent night or resting pain

High levels of reported disability on standardized self-report outcome tools

Pain occurs before end ranges of active or passive movements

Active ROM is significantly less than passive ROM due to pain
Modalities

Heat for pain modulation

Electrical stimulation for pain modulation
Self-care/home management training

Patient education on positions of comfort and activity modifications to limit tissue inflammation and pain

Postural education
Treatment Received in Clinic

Manual therapy: o Low-intensity joint mobilization procedures in the pain-free accessory ranges and glenohumeral positions

Mobility exercises: Pain-free PROM/AAROM o Pulleys ROM flex/abd/IR o Cane AAROM
 Supine flexion
 Supine External Rotation
 Standing Abduction
 Standing Extension o Standing Internal Rotation with towel
Home Exercise Program

10 Repetitions, 1-5 second hold, performed 2-3 times each day. Pain-free ROM o Cane AAROM:
 Supine flexion
 Supine External Rotation
 Standing Abduction
 Standing Extension o Standing Internal Rotation with towel
Reviewed by Alex Jahangir, MD, Orthopaedic Patient Care Center Medical Director, and Heather Skaar, PT, Administrative Director, 5/2014

Characterized by:

Reports moderate levels of pain (4-6/10)

Intermittent night or resting pain

Moderate levels of reported disability on standardized self-report outcome tools

Pain occurs at end ranges of active or passive movements

Active ROM similar to passive ROM
Modalities

Heat for pain modulation as needed

Electrical stimulation for pain modulation as needed
Self-care/home management training

Patient education on progressing activities to gain motion and function without producing tissue inflammation and pain

Postural Education
Treatment Received in Clinic

Manual therapy o Moderate-intensity joint mobilization procedures, progressing amplitude and duration of procedures into tissue resistance without producing posttreatment tissue inflammation and associated pain

Stretching exercises o Gentle to moderate stretching exercises, progressing the intensity and duration of the stretches into tissue resistance without producing posttreatment tissue inflammation and associated pain o Pulleys ROM flex/abd/IR o Cane AAROM:
 Supine flexion
 Supine External Rotation
 Standing Abduction
 Standing Extension o Standing Internal Rotation with towel

Neuromuscular re-education o Procedures to integrate gains in mobility into normal scapulohumeral movement o Rhythmic stabilizations (RS) with scapular stabilization
 ie manual RS, ball circles/protraction-retraction on wall, progressing elevation as
ROM allows
Home Exercise Program

10 Repetitions, 5-15 second hold, performed 2-3 times each day. Pain-free ROM

Continued AAROM as before but into joint resistance, with progression to below: o Wall slide flexion with scapular retraction o Doorway external rotation o Cross-body stretch o Sleeper stretch o Scapular retraction progressing to theraband row
Reviewed by Alex Jahangir, MD, Orthopaedic Patient Care Center Medical Director, and Heather Skaar, PT, Administrative Director, 5/2014

Characterized by:

Reports minimal levels of pain (3/10)

No night or resting pain

Minimal levels of reported disability on standardized self-report outcome tools

Pain occurs with overpressures into end ranges of passive movements

Active ROM same as passive ROM
Self-care/home management training

Patient education on progression to performing high-demand functional and/or recreational activities

Postural Education
Treatment Received in Clinic

Manual therapy o End-range joint mobilization procedures, high amplitude and long duration of procedures into tissue resistance

Stretching exercises: Low load, long duration stretches o Stretching exercises, progressing the duration of the stretches into tissue resistance without producing posttreatment tissue inflammation and associated pain

Neuromuscular re-education o Procedures to integrate gains in mobility into normal scapulohumeral movement during performance of the activities performed by the patient during his/her functional and/or recreational activities
Home Exercise Program

5 Repetitions, 30-60 second hold, performed 2-3 times each day o Wall slide flexion with scapular retraction o Doorway external rotation o Cross-body stretch o Sleeper stretch

Prone rows and shoulder extensions, adding horizontal abduction and scaption as ROM allows
The above was put together based on the below reference:
Kelley M, Shaffer M, Kuhn J, Michener L, et al. Shoulder pain and mobility deficits: adhesive capsulitis, clinical practice guidelines linked to the international classification of functioning, disability, and health from the orthopeadic section of the American Physical Therapy Association. J Orthop Sports Phys Ther.
2013; 43(5): A1-A31.
Reviewed by Alex Jahangir, MD, Orthopaedic Patient Care Center Medical Director, and Heather Skaar, PT, Administrative Director, 5/2014