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Therapy. Facillty ofPhysicalTherapy (FrozenShoulder-AdhesiveCapsulitis) Manar Ahmed Kamel Irene Elia Sedky Fatima Hammam Yahya Habiba Wael Ahmed.

[image] Frozen Shoulder (Adhesive Capsulitis). (Shoulder Complex joints).

(Shoulder joint capsule).. [image] Remember: Shoulder joint capsule • The joint capsule that surrounds the glenohumeral joint is also an important passive stabilizer of the shoulder joint. • The glenohumeral joint capsule is thickened anteriorly and is twice the size of the humeral head. • It provides most of its extensibility anteriorly and inferiorly and it "Winds up" during abduction and external rotation. • The joint capsule and glenohumeral ligaments are intimately adherents anatomically and mainly function as stabilizers at the extremes of motion. • The joint capsule has an inherent negative intra-articular pressure that holds the joint together..

[image] What is Frozen Shoulder? Frozen shoulder Adhesive capsulitis (AC), involves pain in the shoulder joint and later progressively restricted active and passive glenohumeral (GH) joint range of motion(stiffness). Signs and symptoms typically begin slowly, then get worse. Over time, symptoms get better, usually within 1 to 3 years. Frozen Shoulder (Adhesive The buildup Of scar tissue restricts movement inside the resulting in pain and severely limiting motion. Scapu ia.

[image] Common names for Frozen Shoulder include: • Adhesive Capsulitis • Painful stiff shoulder • or an Idiopathic restriction of shoulder movement What is the main cause of frozen shoulder (adhesive capsulitis)? • The condition occurs when inflammation causes your shoulder joint capsule to thicken and tighten (fibrosis of the GH joint capsule). • Thick bands of scar tissue called adhesions develop over time, and you have less synovial fluid to keep your shoulder joint lubricated. • This makes it more difficult for your shoulder to move and rotate properly (gradually progressive stiffness and significant restriction of range of motion (typically external rotation)..

[image] Who's at risk for developing frozen shoulder? I-Age: Frozen shoulder most commonly affects adults between the ages of 40 and 60 years old. 2- Gender: The condition affects females more often than males. 3- Recent shoulder injury: Any shoulder injury or surgery that results in the need to keep your shoulder from moving 'immobilization' (for example, by using a shoulder brace, sling, shoulder wrap) increases your risk of frozen shoulder. Examples include a rotator cuff tear and fractures of vour shoulder blade or upper arm..

(Freezing Phase).. [image] 2- Observation of Posture and Positioning: Scapular winging of the involved shoulder may be observed from the posterior and/or lateral views. 3- Screen: Upper quarter exam (UQE) and neurological screen (dermatomes, myotomes, reflexes) to rule out cervical spine involvement or any neurological pathologies. 4- Assessment of the GH and the Coracohumeral ligaments.

(Frozen Phase).. [image] Remember: Coracohumeral Ligament: • Covers the superior glenohumeral joint anteriorly-superiorly. Acromioclavicular Ligament Coracoacromial Ligament Coracohumeral Ligament Transverse Humeral Ligament Conoid Ligament Trapezoid Ligament Coracoclavicular Ligament.

(Thawing Phase).. [image] 5- Range of Movement Assessment - Active/Passive/Overpressure: • Cervical, thoracic, shoulder ROMs assessment should be done • Reduced forward flexion, abduction, external rotation, and internal rotation range of motion are key clinical signs of frozen shoulder (Shoulder Flex/ABd/ER/lR) • Scapular substitution frequently accompanies active shoulder motion • Patients with frozen shoulder commonly present with ROM restrictions in a capsular pattern. • A capsular pattern is a proportional motion restriction unique to every joint that indicates irritation of the entire joint. The shoulder joint has a capsular pattern where external rotation is more limited than abduction which is more limited than internal rotation (ER limitations > ABD limitations > IR limitations. • In the case of frozen shoulder, ER is significantly limited when compared to IR and ABD (patient would have the greatest limitation in passive external (lateral) rotation followed by the next limitation in passive abduction, and then the last limitation in passive internal (medial) rotation according to Cyriax..

(Observation & Palpation). [image] 7- Special Tests: A- Shoulder Shrug Sign (inability to lift the arm to 900 abduction without elevating the whole scapula or shoulder girdle). 4 umited abductbn Normal metion.

(Assessment of ROM).. [image] B- 3 function tests: (for measuring shoulder dysfunction) The tests mimic fundamental ADL movements Hand to neck IA) Shoulder flexion + abduction + ER Similar to ADLs such as combing hair. putting on a necklace Hand to scapula (Figure 1B) Shoulder extension + adduction + IR Similar to ADLs such fitting a bra, putting on a jacket, getting into back pocket Hand to opposite seapula IC) Shoulder flexion + horizontal ADDuction (The ScarfTest - cross body adduction). These tests require appropriate elbow, scapulothoracic, and thoracic mobility and these areas should be cleared ofpathology first. If a patient is unable to complete the motion, other structures outside of the shoulder joint may be the limiting factor..

(Capsular Pattern).. [image] Second Phase: Decreased Range of Movement I- Gentle and specific shoulder joint mobilisation and stretches, muscle release techniques, acupuncture, dry needling and exercises to regain your range, strength and tunction. • Care must be taken not to introduce any exercises that are too aggressive. • In particular, mobilisation with movement (MWM) techniques can correct scapulohumeral rhythm 2- Shoulder Dynamic splint System (SDS): for daily end range stretching. The combination of physical therapy With dynamic splinting had significant improvements in active, external rotation in patients with frozen shoulder..

(Differential Diagnosis).. [image] Differential Diagnosis • Some conditions can present with similar impairments and should be included in the differential diagnosis: I-Shoulder Osteoarthritis (OA). Both may have limited abduction and external rotation AROM but with OA, PROM will not be limited.. 2- Acromioclavicular joint dysfunction: Likely to occur with a high arch of pain, pain with a cross-body adduction (Scarf Test), and palpation of the acromioclavicular ioint itself. 3- Bursitis. 4- Rotator Cuff (RC) Pathologies. The primary way to distinguish RC pathologies from frozen shoulder is to examine the specific ROM restrictions. Adhesive capsulitis presents with restrictions in the capsular pattern . 5- "Active Muscle Guarding" (Motor Control Dysfunction) 6- Posterior dislocation, or a proximal humeral fracture..

(Management/Goals).. [image] Isometric strengthening Theraband exercises BANDED INTERNAL ROTATION LATERAL RAISE (900) EXTERNAL ROTATION Isometric extemal rotation Isometric internal rotation.

(Joint Mobilization).. [image] 2- Active assisted end-range movements in internal rotation, horizontal adduction and flexion..

(Stretching Exercises).. [image] 6- Mobilization • Posterior glenohumeral glides in supine facilitate the arthrokinematic motions of flexion and internal rotation Of the shoulder • Inferior glenohumeral glides facilitate arthrokinematic motions associated with shoulder abduction • Anterior glenohumeral glides facilitate the arthrokinematic motions of extension and external rotation of the shoulder..

(Strengthening).. [image] D- Advanced Scapular Stabilization Exercises: 10- Modified Plank Press Ups 11. Table Push ups.

(Pain management/Modalities).. [image] 4- Surgical procedures: If these noninvasive treatments haven't relieved your pain and shoulder stiffness after about a year, your provider may recommend other procedures. These include: I- Manipulation under anesthesia: During this surgery, you'll be put to sleep and your provider will force movement of your shoulder. This will cause your joint capsule to stretch or tear to loosen the tightness. This will lead to an increase in your range of motion. 2- Shoulder arthroscopy: Your provider will cut through the tight parts of your joint capsule (capsular release). They'll insert small, pencil-size instruments through small cuts (incisions) around your shoulder. • Providers often use these two procedures together to get better results..

(Surgical Treatment).. [image] Manipulation under Anesthesia (MUA) Adhesive capsulitis/"frozen shoulder" unresponsive to rehab SHOULDER ARTHROSCOPIC.

(SINSS model). [image] Remember: • The Severity, Irritability, Nature, Stage and Stability (SINSS) model is a reasoning construct to provide clinicians with a structured framework for taking subjective history, in order to determine an appropriate objective examination and treatment plan, and reduce clinical reasoning errors,.