Adhesive Capsulitis (Frozen Shoulder) PDF

ADHESIVE CAPSULITIS (FROZEN SHOULDER : Prepared by Dr. sahar mowad  well-defined disorder characterized by progressive pain and stiffness of the shoulder which usually resolves spontaneously after about 18 months. The cause remains unknown. The condition is pa...

ADHESIVE CAPSULITIS (FROZEN SHOULDER : Prepared by Dr. sahar mowad  well-defined disorder characterized by progressive pain and stiffness of the shoulder which usually resolves spontaneously after about 18 months. The cause remains unknown. The condition is particularly associated with diabetes, Dupuytren’s disease, hyperlipidaemia, hyperthyroidism, cardiac disease and hemiplegia. It occasionally appears after recovery from neurosurgery Clinical features aged 40–60 a history of trauma, often trivial, followed by aching in the arm and shoulder Pain gradually increases in severity and prevents sleeping on the affected side , After several months it begins to subside stiffness becomes an increasing problem, continuing for another 6–12 months after pain has disappeared  Gradually movement is regained, but it may not return to normal and some pain may persist lack of active and passive movement in all directions. X-rays are normal unless they show reduced bone density from disuse. Their main value is to exclude other causes of a painful, stiff shoulder Diagnosis (1)Painful restriction of movement in the presence of normal xrays (2) a natural progression through three successive phases. Shoulder pain – the scratch test Differential diagnosis In patients with diabetes Inf During the first day or two, signs of inflammation may be absent Po ect st- ion tra u After any severe shoulder injury m It is maximal at the start and gradually lessens, unlike the pattern ati of a frozen shoulder. c sti Dif ffn fus following a forearm fracture) the shoulder may stiffen ese s stif fne ss Ref lex Shoulder pain and stiffness may follow myocardial infarction sy mp or a stroke ath In severe cases the whole upper limb is involved, with trophic eti and vasomotor c changes in the hand (the ‘shoulder–hand syndrome’). dy str op hy  Treatment analgesics and antiinflammatory drugs Physical therapy and rehabilitation Manipulation under general anaesthesia  Physical therapy rehabiltation Painful Stage  Pain modulation techniques include gentle distractions with perturbations and possibly the use of transcutaneous electrical neuromuscular stimulation (TENS) or other modulators to control pain  Instead of asking the patient to relax in a flexed standing posture, we ask patients to grasp the involved arm’s elbow with the uninvolved hand. They then raise the flexed arm forward supporting the weight of the arm with the uninvolved extremity (codman exercises)  ◆ Freezing Stage During the freezing stage, the patient exhibits significant loss of motion (ER→elevation →IR). Patients have significant pain as they pproach their end ROM and frequently decrease use of the arm to minimize pain. Treatment focus should be on maintenance of range Treatment should be gentle extension of the arm within the available range but not making the end range  If patients are experiencing sleep disturbances, we recommend pillow on thorax positioning and gentle patient Codman if they are awakened by pain to facilitate return to sleep. no aggressive stretching or resistive exercises should be performed during this stage educate the patient “to climb the wall” in the scapular plane as a gentle elevation- oriented ROM exercise  Frozen Stage  patients demonstrate a limitation of motion but experience relatively minimal pain  can use their residual ROM and function within that range relatively well  do strengthening, exercise done within the available range  can go to the end range more easily because there is much less pain or end-range sensitivity.  manipulation can be done at this stage.  We do not recommend attempting aggressive stretching but rather setting a regimen that will maintain their present ROM less-positive responses in diabetic patients who have undergone manipulation, even in the frozen stage  Thawing Stage  The hallmark of the thawing stage is the return of motion  it is not the return of normal capsular volume because patients do not regain a normal capsule  They regain significant motion; some residual loss is present in about half the patients  During this stage, physical therapists may use a variety of stretching maneuvers with success For treatment in this ,stage (1) mobilize the scapula—move the scapula over your fingers— don’t dig your fingers under the scapula  (2) mobilize the clavicle—bring your thumb horizontally into the posterior soft spot to move the clavicle anteriorly while the arm is supported  (3) use soft tissue techniques on the subscapularis, pectoralis minor, and external rotators to reduce their inherent muscle–tendon tension—you may use trigger point releases or deep tissue pressure approaches to minimize the restrictive nature of these structures prior to stretching patterns during the therapy sessions