Adhesive capsulitis case presentation physiotherapy

Satisfactory presentation on adhesive capsulitis because of satisfactory results in 2 weeks.
Can do these exercises to increase range
Muscle strength and overall well being.

1. ADHESIVE CAPSULITIS Manisha BPT intern 26 th batch

2. 3 Stages Stage 1 (freezing phase) Duration : 2-9 months Stage 2 ( frozen phase) Duration 3-18 months Stage 3 (thawing stage ) Duration: beyond 18 months

3. Demographic data Name : Prarthana Chaudhary Age: 49 years Sex: female Occupation: housewife Date of examination: 31.10.2019 Patient ‘s complaint : inability to lift arm above head level and difficulty in activities like ,combing ,dressing, bathing etc due to shoulder pain

4. History Duration of symptoms : 3-4 months Onset of symptoms: insidious onset of pain and restriction of movements. PAIN Location : anterolateral arm and shoulder Quality : i ntermittent Intensity : 6-7 on VAS Aggravating factors : Overhead activities, touching back , Relieving factor : HWF

5. Medical history Diabetes Hypertension HISTORY OF TRAUMA H/o fall or sudden jerk to the shoulder - absent

6. Observation POSTURE Cervical spine : no forward head posture Shoulder : Normal Scapula : Normal ( not protracted or abducted) Thoracic spine : normal Lumbar : normal lordosis present Pelvis : no abnormal tilt Scapulohumeral rhythm: excessive scapular movements during elevation in initial phase

7. Inspection Skin Color - normal , no signs of inflammation Scar – not present Soft tissue inspection Swelling- not present Muscle contours- normal when compared with normal side. Gait - inadequate arm swing Attitude of affected upper extremity- arm by the side End feel : firm

8. Mobility Range of motion:shoulder Active range of motion Passive range of motion Flexion 120 125° Extension 20 25 Abduction (frontal plane) 80° 90° Elevation in scapular plane 110 120 External rotation with 0° abduction 10° 12° Internal rotation with 90° abduction 25° 30°

9. Cervical motion Movements Ranges Flexion 45° Extension 60° (Left )side flexion 40 (Right )side flexion 40 (Left ) rotation 70 (Right ) rotation 70

10. Manual muscle testing Shoulder muscle test in the available range Muscle group Left shoulder (affected) Resisted isometrics (Affected) Right shoulder (normal side) Flexors 3+ Painfree in neutral Painful in mid range 5 Extensor 4- Painfree Abductors 3+ Painful in middle range 5 Adductors 4+ Painfree 5 Horizontal adductors 4+ Painfree 5 External rotators 4- Painfree 5 Internal rotators 4 Painfree 5

11. Scapula muscle test Muscle Left (affected) Right (normal) Serratus anterior Cannot be tested bcoz of pain 5 Middle trapezius 3 +(applying resistance –painful) 5 Lower trapezius Cannot be tested bcoz of limited range 5 Rhomboids Cannot be tested 5

12. Special test Apleys scratch test – positive ROTATOR CUFF lesion/impingement/tendinitis .Hawkins Kennedy test- .speed test – Empty can test- * False positive on day 1 because of pain and muscle spasm

13. Apley’s scratch test Internal rotation with adduction and extension.

14. DIAGNOSIS Adhesive capsulitis(idiopathic) adhesions around the Joint capsule as well as ligaments and tissues lining the joint capsule.

15. Management AIM Pain relief To gain range of motion muscle strengthening Maintain range of motion and muscle strength return to Functional activitise PAIN RELIEF Hot pack on left shoulder -10 min To relax muscles ,pain relief and increase pliability of soft tissues. .Pulsed ultrasound 0.8 W /cm2 to increase extensibility of joint capsule . Night pain – cold pack for 15 min

16. Day 1 &2 Exercise protocol . Scapular PNF pattern for scapula stabilization And pain relief .hold relax - shoulder adductors - shoulder extenders To relax and stretch adductors and extensors .oscillations for pain relief

17. Day 3 & 4 Gental mobilization of shoulder Inferior glide Posterior glide Anterior glide * 4-5 glides .hold relax stretching Strengthening in newly gained range. Manual resistance Rhythmic stabilization Dynamic reversals

18. Home exercise protocol Codman’s exercises Active assisted flexion Isometric shoulder external /internal rotation Active abduction/against wall Anterior Capsular stretching

19. Day 5 onwards Mobilization of shoulder 10 glides ( inferior ,anterior ,posterior) Mobilization with movement for scapula in scaption plane and frontal plane strengthening (alternating isometrics) Hold relax ,contract relax stretching Capsular stretching (anterior capsule ,posterior capsule ,inferior capsule) Finger ladder for active assisted flexion and abduction

20. Day 14 DAY 1

21. Day 14 DAY 1

22. Range of motion Movements (active) Day 1 Day 14 Flexion 120° 140° Extension 20 35 External rotation (neutral) ER at 90°abd 10 ° - 30° 20° Abduction (frontal plane) 80° 120° Internal rotation 25° 40° Elevation in scapular plane 110 140°

23. Day 14 Can reach behind the neck

24. SHOULDER PAIN & DISABILITY INDEX (SPADI) Pain scale Before PT management After 2 wks of PT At its worst ? When lying on the involved side ? Reaching for something on a high shelf? Touching back of your neck? Pushing with the involved arm? 7 5 6 3 7 6 3 5 2 4 5×10=50 28 20 Total pain score (%) (28÷50)×100=56% 40%

25. Disability scale Functional activities Before After 2 wks Washing your hair? Washing your back? Putting on undershirt? Putting on your suit? Putting on your salwar? Placing an object on a high shelf ? Carring a heavy object ? Removing something from your back pocket 6 7 5 7 3 7 6 7 4 5 4 5 1 5 5 5 Total disability score 80 48 34 Disability Percentage 60% 42.5% Total SPADI SCORE 58.46% 41.53%

26. Review MMT Shoulder muscles

27. Mmt scapular muscles

28. Can Hold end position in newly gained range of motion . Night pain : before treatment 6-7 After PT treatment 2 . Special test Empty can test – negative Speed test – negative SPADI decreased from 58 % to 41%