Peri arthritis shoulder/ frozen shoulder

Definition , sign, symptoms, stages ,management & prevention about periarthritis shoulder

1. PERIARTHRITS SHOULDER Presented by:- Pushpendra Yaduvanshi Asst . prof. & Head Department of physiotherapy, Career point university Kota

2. PERI ARTHRITIS SHOULDER

3. INTRODUCTION The periarthritis of shoulder also called as adhesive capsulitis or ,Frozen shoulder, is a chronic, inflammatory disorder of the shoulder and surrounding soft tissues. This condition is frequently caused by injury, leading to pain and lack of use.  As the joint becomes progressively tighter and stiffer, simple movements, such as raising the arm, become difficult. 

4. DEFINITION Peri arthritis Shoulder is a condition in which there is inflammation of tissues around the joint capsule. The Gleno -humeral joint (that is the shoulder joint) becomes painful and stiff.

5. SIGNS Inspection 1)Patient holds arm protectively at side 2)Deltoid and Supraspinatus atrophy Palpation 1)Generalized pain at rotator cuff and biceps tendon.

6. Limited range of motion 1)Loss of both active and passive Shoulder Range of Motion 2)Loss of motion in all planes

7. SYMTOMS Painful shoulder Stiffness in shoulder Difficulty to reach overhead at all times and all the movements of shoulder are severely limited .

8. According to CYRIAX , there are 3 stages of symptoms Stage 1: Pain persists in shoulder It does not spread beyond elbow. Person can sleep on the affected side. Pain remains only in movement. Stage 2: This stage is not clear but any symptom exceeding beyond stage 1, is considered to be stage 2.

9. Stage 3: Pain extends till wrist. Person can’t sleep on the affected side. Vague chill pain on movement. In early stages, the pain is worse in night. Later pain is present

10. FROZEN SHOULDER IS CLASSICALLY CHARACTERIZED BY THREE STAGES Stage 1 – The painful/freezing stage. There is usually a dull, aching pain onset of predominantly nocturnal pain, usually without a precipitating factor. The pain is not related to activity, although the end range of motion can increase the pain. As the disease progresses, patients have pain at rest which lasts 2-9 months, ROM is not restricted.

11. Stage 2 – This is known as the adhesive/frozen stage . The shoulder typically becomes increasingly stiff, daily activities such as grooming one’s hair, reaching for a seatbelt, ove becomes difficult. Although the pain does not normally get worse, the muscles may start to waste slightly as they are not being used.

12. Stage3 - This is the recovery/thawing stage in which you gradually regain movement of the shoulder. The pain also fades, although it may recur from time to time as the stiffness eases. Although it is possible that you may not regain full movement of your shoulder, you will be able to do many more tasks than previous stage. This stage can last any period of time from five months to 3-4 years.

13. CAUSES Periarthritis Shoulder is usually a disease of unknown cause. In some cases there is a history of previous trauma or injury to the joint before the onset of condition. This condition occurs when a person is not using the shoulder joint, keeping it in a guarded way with less movement, due to pain. This reduces the flexibility of the joint. Which in-turn causes reduction in the movements of shoulder like flexion (forward movement), extension (backward movement), abduction (sideways movement) and rotational movements.

14. Age and Sex People 40 and older are more likely to experience frozen shoulder More common in women (especially in postmenopausal  women)  than men

15. Prolonged Immobility In period of immobility your arm and shoulder remains immobile (still) for long periods of time while you recover which may cause your shoulder capsule to tighten up from lack of its use. For Example: In rotator cuff injury, brachial plexus injury, cervical spinal cord injury Stroke Fracture at or around shoulder. Recovery from surgery (chest or breast surgery)

16. Endocrine abnormalities such as: Diabetes Hyperthyroidism Systemic diseases Heart disease Parkinson’s disease

17. Frozen Shoulder Facts 2-5% of the population. It is more common in women (60%) It is at least five times more common in diabetics It is slightly more common in patients with Dupytren’s contracture and shares some of the same pathology About 15% of people get it on both sides

18. It may have a genetic component i.e./ it can run in the family It may well have an hyper responsive auto-immune component It seems to affect 40-70 year olds (in Japan it is known as 50’s shoulder) About 15% of people get it on both sides

19. This reduces the flexibility of the joint. Which in-turn causes reduction in the movements of shoulder like flexion (forward movement), extension (backward movement), abduction (sideways movement) and rotational movements.

20. Mechanism by which a Frozen Shoulder occurs The shoulder capsule becomes inflamed and stiff, usually due to an injury The inflammation may cause bands of tissue (adhesions) to develop between your joint's surfaces. Synovial fluid, which helps to keep your joint lubricated and moving smoothly, may decrease. As a result, pain and subsequent loss of movement may occur. In some cases, mobility may decrease so much that performing everyday activities — such as combing your hair, brushing your teeth or reaching for your wallet in your back pocket — is difficult or even impossible.

21. DIAGNOSIS X-rays —a test that uses radiation to take pictures of structures inside the body, to rule out other possible causes of the stiffness MRI scan —a test that uses magnetic radiation waves to make pictures of the tissues in the body, used to examine the soft tissues around the shoulder Arthrograms —x-ray pictures taken after dye is injected into the shoulder area. This test is difficult to perform with this shoulder condition.

22. MANAGMENT Medical Treatment Anti-inflammatory Medications Anti-inflammatory medications have not been shown to significantly alter the course of a frozen shoulder, but these medications can be helpful in offering relief from the painful symptoms. Cortisone Injections Cortisone injections are also commonly used to decrease the inflammation in the frozen shoulder joint. It is unclear the extent of the benefit of a cortisone injection, but it can help to decrease pain, and in turn allow for more stretching and physical therapy. What is known, is the cortisone is only effective when used in conjunction with physical therapy for the management of a frozen shoulder.

23. Surgery Surgery is an option if there is no improvement after 4 to 6 months of intensive therapy. Surgeries include: Closed manipulation:- This involves forceful movement of the arm at the shoulder joint to loosen the stiffness. This is performed under anesthesia and followed by intensive physical therapy.

24. Arthroscopic surgery An arthroscope , which is a long, thin, fiberoptic tube with a light on the end, is inserted through a small incision in the shoulder. Using this tube and other small instruments, the tightened tissues are released and the shoulder is manipulated. Physical therapy must be done after this surgery

25. Prevention To help prevent frozen shoulder: Do regular strength training and range of motion exercises. This will help maintain a strong and flexible shoulder joint. Seek prompt treatment for a shoulder injury. Do activities that use your shoulder joint regularly. After any injury to the upper extremity (hand, wrist, elbow, etc), always move the shoulder through a full range of motion several times a day.

26. REFERENCES Clinical orthopaedic rehablitation S. brent brotzman . Orthopeadic physical Assessment David j. magee . Essentials of orthopeadics & applied physiotherapy. Jayant joshi . www.google.com

27. THANK YOU