Frozen Shoulder Physiotherapy Management

Frozen Shoulder,Adhesive Capsulitis,Peri Arthritis Shoulder

1. Management Vishal Deep Final Year BPTh

2. Introduction It is a clinical syndrome characterized with painful restriction of both active and passive shoulder movements

3. Medical Management Corticosteroid injections are often used to manage inflammation as it is understood that inflammation is a key factor in the early stages of the conditio Methyl- prednisolonee and Triamicinolone Non-steroidal anti-inflammatory drugs (NSAIDs) have traditionally been given to patients with adhesive capsulitis. Ibuprofen Naproxen

4. Oral steroids   have also been utilised in these patients and result in some improvement in function, but their effects have not shown long term benefits and combined with their known adverse side effects

5. Manipulation under anaesthesia Manipulation under anesthesia involves a controlled and forced, end range positioning of the humerus relative to the glenoid in physiologic planes of motion in patients with an anesthetic block to the brachial plexus

6. Translation Mobilization under anaesthesia This dureedure involves the use of gliding techniques with static end range capsular stress with a short amplitude high velocity thrust, if needed, as opposed to the angular stretching forces in manipulation under anesthesia .

7. Surgical Management Arthroscopic capsular release Arthroscopic capsular release is the preferred method over open release in patients with painful, disabling adhesive capsulitis that is unresponsive to at least 6 months of non-operative treatment

8. Physiotherapy Management

9. Short term goals Patient and family education Reduce pain Improve range of motion Improve muscle strength

10. Long term goals Maintain Range of motion Maintain muscle strength To make the patient functionally independent to perform his ADL Ergonomic Advice Home program

11. Patient and Family education For the treatment of adhesive capsulitis, patient education is essential in helping to reduce frustration and encourage compliance. . It is also helpful to give quality instructions to the patient and create an appropriate home exercise program that is easy to comply with as daily exercise is critical in relieving symptoms.

12. To reduce pain Ultrasound – continuous mode Chronic conditions initially 0.8 Wcm2 For 4 mins Hot pack – muscle relaxation Maitland Mobilization grade I and II

13. To improve range of motion Passive Range of motion exercise Mobilization Active assisted Exercise Active Exercise Stretching Aquatic therapy

14. Mobilization Maitland Mobilization Posterior glide to improve flexion range Inferior glide to improve Abduction range Maitland mobilization grade I and II for pain relief grade III and IV to improve ROM

15. Stretching to increase shoulder flexion with elevation

16. To increase external rotation

17. To improve Abduction

18. Wand exercise FLEXION

19. EXTENSION

20. ABDUCTION ADDUCTION

21. Internal and external rotation

22. To improve muscle strength Isometrics Isometrics at different Angles

23. Rotator cuff strengthening- three times per week, 8 to 12 repetitions for three sets  • Closed-chain isometric strengthening with the elbow  flexed to 90 degrees and the arm at the side.

24. • Progress to open-chain strengthening with Therabands,Weight cuff,Sand bags,springs    • Theraband exercises permit concentric and eccentric strengthening of the shoulder muscles and are a form of isotonic exercises (characterized by variable speed and fixed resistance)   

25. • Progress to light isotonic dumbbell exercises  Internal rotation. E xternal rotation

26. Strengthening of scapular stabilizers  • Closed-chain strengthening exercises Scapular retraction ( rhomboideus , middle  trapezius ).  Scapular protraction ( serratus anterior) Scapular depression ( latissimus dorsi , trapezius ,  serratus anterior).  Shoulder shrugs ( trapezius , levator scapulae). 

27. • Progress to open-chain strengthening

28. Deltoid strengthening

29. Progressing to open chain strengthening Progressive resisted exercise . Delorme protocol

30. Home program Pendular exercise Wall exercise Aquatic therapy Wand exercise Press ball againts wall Writing on board

31. Ergonomic advice Depending upon the occupation of the patient

32. Advice Avoid jerky movement or stretching Avoid lifting heavy weights Avoid Hand shakes Avoid any impact

33. REFRENCE Clinical Orthopaedic Rehabilitation- Dr. S. Brent Brotzman and Robert C. Manske Therapeutic Exercise Foundations And Techniques- Carolyn Kisner Lynn Allen Colby