Frozen Shoulder

Frozen Shoulder is also called Adhesive Capsulitis ,

1. Frozen Shoulder Workshop # 1

2. Definition : Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by stiffness and pain in your shoulder joint . A dhesive capsulitis as the pathology involves the capsule of the joint

3. Incidence is 2% Seen in women more commonly than men during the 5 th to 7 th decade Bilateral involvement occurs in 10 to 40 % of cases Does not usually recurrence in the same shoulder Frozen shoulder typically develops slowly, and in three stages .

4. Shoulder Anatomy HUMERUS SCAPULA CLAVICLE GLENOID 5. ACROMION HEAD OF HUMERUS CORACOID

5. Surface Anatomy

6. SHOULDER COMPLEX Gleno -Humeral Joint Sterno-Clavicular Joint Acromio- C lavicular Joint Coroco-Clavicular Joint Scapulo - Thoracic Joint

7. BIOMECHANICS

8. What is Stiff? Patient - “I cant move my shoulder as well ‘cos it hurts” Us - Reduction in active and passive glenohumeral joint movement compared to the contralateral side

9. 3 N’s Neck (or neural) Not moving - true stiffness Nasty (Infection, Malignancy)

10. Neck Radicular pain - extending below elbow, occasionally medial scapula (c3/4) S houlder should be painfree to passive ROM

11. True Stiffness Reduction in Passive and active glenohumeral joint movement Limitation due to bony abnormality Osteoarthritis Missed Dislocation

12. Nasty Night and Unremitting pain Red flags history of malignancy unexplained weight loss

13. Causes 14 Lundberg classified in to primary and secondary frozen shoulder PRIMARY FROZEN SHOULDER No inciting event, normal plain radiographs and no findings other than loss of motion SECONDARY FROZEN SHOULDER Precipitant traumatic event

14. PRIMARY FROZEN SHOULDER 15 No inciting event but INTRINSIC AND EXTRINSIC predisposing factors present INTRINSIC factors like age between 40 and 60 years of age, female sex, Diabetes mellitus EXTRINSIC factors may include immobilization and faulty body mechanics

15. Stages Of Frozen Shoulder 1. Freezing / Painful 2. Frozen / Stiffening 3. Thawing / Recovery

16. Freezing stage : Develop a pain in your shoulder any time you move it. It slowly gets worse over time and may hurt more at night. This can last anywhere from 6 to 9 months. You’re limited in how far you can move your shoulder.

17. Frozen stage : Your pain might get better but your stiffness gets worse. Moving your shoulder becomes more difficult and it becomes harder to get through daily activities. This stage can last 4-12 months.

18. Thawing stage : Your range of motion starts to go back to normal. This can take anywhere from 6 months to 2 years.

19. DIFFERNTIAL DIAGNOSIS 1. Shoulder Osteoarthritis PROM will not be limited. limitations with flexion. Radiography 2. Bursitis most motions being painful. amount of PROM achieved. will have a larger PROM But painfull . 3. Posterior Dislocation Unable to fully supinate the arm while flexing the shoulder . 4. Rotator Cuff Pathologies No capsular pattern. Radiology is usefull . 5. Parsonage-Turner Syndrome inflammation of the brachial plexus. painful restrictions of all motions. neurological problems

20. DI A GNOSIS 22 Campbell decribes presence of 3 features to diagnose frozen shoulder : Internal rotation restricted upto the point when the patient cannot touch beyond his sacrum 50% loss of external rotatio n < 90 degrees of abduction

21. Treatment Counselling Physical therapy Surgery Manipulation Under Anesthesia. Arthroscopic Capsular Release. Mediction : NSAIDS Anti-inflammatory Steroid injection

22. Manual Therapy Anterio - Posterior Glide Inferior Glide Scapular Mobilization Maitland Mobilization Grades Movement With Mobilization Muscle Energy Technique 7. Stretching 8. Strengthing 9. Functional Movement 10. Home Plan

23. Anterior Glide

24. Posterior Glide

25. Inferior Glide

26. Scapular Mobilization

27. Maitland Mobilization

28. Movement with Mobilization (ER)

29. Movement with Mobilization (IR )

30. Muscle Energy Technique (IR)

31. Muscle Energy Technique (AD)

32. Stretching

33. Strengthening

34. Functional Movement

35. Home Advice Getting the arm up while lying down. Getting the arm up overhead while sitting down. Getting the arm to externally rotate while lying down .

36. Getting the arm up the back . Getting the arm across the body . Pendulum exercise. Wall ladder / climbing . Catch something from away. Home Advice

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