Frozen Shoulder and Adhesive Capsulitis
PERIARTHRITIS
SHOULDER
&
ADHESIVE
CAPSULITIS/FROZEN
SHOULDER
D
E
F
INITION
:
-
1.
Peri-arthritis
Is
A
Common
Condition
Characterised
By
Pain
And
Progressive
Limitation
Of
Abduction
&
External
Rotation
Movement
Of Shoulder Joint
1.
FROZEN SHOULDER, ALSO CALLED ADHESIVE CAPSULITIS,
CAUSES
PAIN
AND STIFFNESS
IN
THE SHOULDER.
OVER
TIME,
THE
SHOULDER
BECOMES
VERY
HARD
TO
MOVE.
2.
FROZEN SHOULDER
OR
ADHESIVE CAPSULITIS DESCRIBES
THE COMMON SHOULDER CONDITION
CHARACTERIZED
BY
PAINFUL
AND
LIMITED
BOTH
ACTIVE
AND
PASSIVE
RANGE
OF
MOTION
IN
ALL
PLAINS
WITH RADIOGRAPHIC
APPEARANCE.
A
r
ound
1.
Immobilisation
Dueto
Fracture
&
Dislocation
The
Shoulder
Jt.
1.
Bicipital
Tendinitis
2.
Rotator
Cuff
Tendinitis
3.
Stroke,
4.
Lung
Disease,
5.
RSD
6.
Thyroid
Disease
----
Hyperthyroidism
7.
Heart
Disease
(CVS)
--
Ischemic
Heart
Diseases
8.
Diabetes
Mellitus- insulin
dependent
diabetes
9.
Tonic
Seizures
10.
Strain
and
Strain
and
Surgical
trauma.
R
i
s
k
f
a
c
t
o
r
s
f
o
r
f
r
o
z
e
n
s
h
o
u
l
d
e
r
/
P
A
i
n
c
l
u
d
e
:
-
YOU
SHOULD
BE
ABLE
TO
MOVE
YOUR
SHOULDER
IN
ALL
DIRECTIONS
WITHOUT
PAIN.
TO
TEST
YOURSELF,
DO
THESE
THINGS:
SHOULDER
STIFFNESS
INABILITY
TO
RAISE
ARM
LIMITED
SHOULDER
MOBILITY
SHOULDER
PAIN
SHOULDER
IMMOBILITY
RADIATING
PAIN
DOWN
ARM
SHOULDER
PAIN;
USUALLY
A
DULL,
ACHING
PAIN
LIMITED
MOVEMENT
OF
THE
SHOULDER
DIFFICULTY
WITH
ACTIVITIES
SUCH
AS
BRUSHING
HAIR,
PUTTING
ON
SHIRTS/BRAS
PAIN
WHEN
TRYING
TO
SLEEP
ON
THE
AFFECTED
SHOULDER
1.
IN
PA
LIMITATION
OF
ABD.
&
ER
OF
GH
JOINT.
2.
PAIN
FROM
FROZEN
SHOULDER
&
PA
IS
USUALLY
DULL
OR
ACHING.
IT
IS
TYPICALLY
WORSE
EARLY
IN
THE
COURSE
OF
THE
DISEASE
AND
WHEN
YOU
MOVE
YOUR
ARM.
THE
PAIN
IS
USUALLY
LOCATED
OVER
THE
OUTER
SHOULDER
AREA
AND
SOMETIMES
THE
UPPER
ARM.
3.
TENDERNESS
FRONT
OF
SH.
JT.
C
l
i
n
i
c
a
l
F
e
a
t
u
r
e
CLASSIFICATION
OF
F.A/A.C
ADHESIVE
CAPSULITIS
IS
CLASSICALLY
CHARACTERISED
BY
THREE
STAGE:-
1)
FIRST
STAGE
(STAGE
OF
PAIN)
----
(
3
TO
6
MONTH)
2)
SECOND
STAGE
(STAGE
OF
STIFFNESS)
---(3
TO
18
MONTH)
3)
THIRD
STAGE
(STAGE
OF
RECOVERY
)-----(6 MONTH
TO
2
YRS.)
1)
FIRST
STAGE
(STAGE
OF
PAIN)
–
IS
THE
FREEZING
STAGE
IS
CHARACTERISED
BY—
*ACHING
PAIN
IN
SHOULDER
*PAIN
MORE
SEVERE
AT
NIGHT WITH
ACTIVITIES.
*PAIN
MAY
RADIATES
DOWN
THE
ARM
*
PATIENTS
ADEPT
THE
ADDUCTION
+
INTERNAL
ROTATION.
*
DISCOMFORT
SHOULDER.
NOTE:-
(
WHEN
IT
IS
TREATED
BY
MOBILISATION
THEN
SYMPTOM
BECOME
WORSEN
THE
FREEZING
PROCESS).
1)
SECOND
STAGE
(STAGE
OF
STIFFNESS)
–
IT
IS
ALSO
CALLED
FROZEN
OR
PROGRESSIVE
STIFFNESS
PHASE
*
PAIN
↓
DURING
REST.
*ADL
SEVERELY
RESTRICTED.
*
SHOULDER
MOTION
RESTRICTED
IN
ALL
PLAIN.
*PATIENT
COMPLAIN:-
1
INABILITY
TO
REACH
IN
TO
BACK
POCKETS.
2
FASTEN
THE
BRA.
3
COMB
THE
HAIR.
4
WASH
THE
OPPOSIT
SHOULDER.
5
PAI
AT
NIGHT.
STAGE
CAN
BE
LAST
FROM
3
TO
18
MONTH
(
NOT:-
EASILY
TREATED
WITH MEDICINE AND
PHYSICAL
THERAPY.)
3)
THIRD
STAGE
(STAGE
OF
RECOVERY
)----
FINAL
STAGE
IS
THROWING
OR
RESOLUTION
PHASE.
IT IS
CHARACTERISED
BY
NO
PAIN
WITH
SLOW
RECOVERY
OF
MOTION.
LOSS
OF
EXTERNAL
ROTATION
WITH
ARM
AT
SIDE
OF
THE
PT.
IS HALLMARK
OF
THIS
CONDITION.
(NOTE:-
AGGRESSIVE
TREATMENT
WITH
PHYSICAL
THERAPY
AS
CLOSE
MANIPULATION
AS
MAITLAND
&
MULLIGAN
ETC.
IF
CONSERVATIVE
MANAGEMENT
IS
FAILED
THAN
SURGICAL
RELEASE
IS
REQUIRED
).
D
I
A
G
N
O
S
I
N
G
O
S
T
E
O
A
R
T
H
R
I
T
I
S
:
-
1.
X
–
R
A
Y
A
P
&
L
A
T
E
R
A
L
V
I
E
W
S
H
O
U
L
D
E
R
.
2.
M
R
I
S
H
O
U
L
D
E
R
3.
O
R
T
H
R
O
S
C
O
P
Y
O
F
S
H
O
U
L
D
E
R
4.
ELEVATED
ERYTHROCYTE
SEDIMENTATION
RATE
[ESR]
5.
C-REACTIVE
PROTEIN
[CRP]
LEVEL)
–
INCREASE
6.
ANTI–CYCLIC
CITRULLINATED
PEPTIDE
[ANTI-CCP]
7.
INFLAMMATORY
JOINT
FLUID
WITH
A
PREDOMINANCE
OF
....POLYMORPHONUCLEAR
LEUKOCYTES
(PMNS)
1.
TLC
&
DLC
,
ELEVATED
WHITE
BLOOD
CELL (WBC)
COUNT
MANAGEMENT
OF
PA/FS
DRUG
MANAGEMENT
1.NSAID:-
ASPIRIN,
CELECOXIB
(CELEBREX),
DICLOFENAC
POTASSIUM
(CATAFLAM),
DICLOFENAC
SODIUM
(VOLTAREN,
VOLTAREN
XR),
DICLOFENAC
SODIUM
WITH
MISOPROSTOL
(ARTHROTEC),
IBUPROFEN,
INDOMETHACIN
(INDOCIN,
INDOCIN
SR),
OXAPROZIN
(DAYPRO),
PIROXICAM
(FELDENE),
ROFECOXIB
(VIOXX)
MEFENAMIC
ACID
(PONSTEL),
MELOXICAM
(MOBIC),
NABUMETONE
(RELAFEN),
NAPROXEN
(NAPROSYN,
NAPRELAN),
NAPROXEN
SODIUM, KETOPROFEN
MANAGEMENT
:-
THE BASIC AIM
OF
FROZEN SHOULDER EXERCISES ARE:
TO
REDUCE
PAIN.
TO
INCREASE
EXTENSIBILITY
OF
THE
THICKENED
AND
CONTRACTED
CAPSULE
OF
THE
JOINT.
TO
IMPROVE
MOBILITY
OF
THE
SHOULDER.
TO
IMPROVE STRENGTH
OF
THE MUSCLE.
HOWEVER
IT
MAY
BE
REMEMBERED
THAT
STRENGTHENING
OF
MUSCLE
IS
SECONDARY
TO
MOBILIZATION.
MANAGEMENT
OF
PA/F.
S.
CLASSIFIED
INTO
THREE
STAGE
:-
1)
FIRST
STAGE
(STAGE
OF
PAIN)
----
(
3
TO
6
MONTH)
2)
SECOND
STAGE
(STAGE
OF
STIFFNESS)
---(3
TO
18
MONTH)
3)
THIRD
STAGE
(STAGE
OF
RECOVERY
)-----(6
MONTH
TO
2
YRS.)
1)
FIRST
STAGE
(STAGE
OF
PAIN)
----
(
3
TO
6 MONTH):-
1.
NSAIDS-
FIRST
LINE
MEDICATION
FOR
PAIN
CONTROL
ASSOCIATED
WITH
ANTACID.
2.
GH
JOINT INJECTION:
CORTICOSTEROID/LOCAL
ANESTHETIC
COMBINATION.
3.
ORAL
STEROID
TAPER-
FOR
PATIENTS
WITH
REFRACTIVE
OR
SYMPTOMATIC
FROZEN
SHOULDER.
4.
THERAPEUTIC
MODALITIES
ICE
FOR
20
MIN,
ULTRASOUND
0.8
TO
1.2
WTTS.
FOR
5
TO
7
MINS,
HVGS
FOR
25
MINS.
APPLY
MOIST
HEAT
BEFORE
THERAPY
AND
ICE
PACK
AT
THE
END
OF
SESSION.
1.
INITIALLY
FOCUS
ON
FORWARD
FLEXION
AND
INTERNAL
AND
EXTERNAL
ROTATION
WITH
THE
ARM
AT
THE
SIDE,
AND
THE
ELBOW
AT
90 DEGREES
.
2.
ACTIVE
ROM
EXERCISES.
3.
ACTIVE
ASSISTED
ROM
EXERCISES.
4.
PASSIVE
ROM
EXERCISES.
5.
A
SUSTAINED
STRETCH,
OF
15-30
SECONDS,
AT
THE
END
ROMS
SHOULD
BE
PART
OF
ALL
ROM
ROUTINES.
6.
IN
HOME
THESE
FROZEN
SHOULDER
EXERCISES
SHOULD
BE
PERFORMED
3-5
TIMES
PER
DAY.
2)
SECOND
&
THIRD
STAGE
(STAGE
OF
STIFFNESS
&
STAGE
OF
RECOVERY
)
---
CRITERIA
FOR
PROGRESSION
TO
STAGE
- 2
IMPROVEMENT
IN
SHOULDER
DISCOMFORT.
IMPROVEMENT
IN
SHOULDER
MOTION.
SATISFACTORY
PHYSICAL
EXAMINATION.
GOALS
*
PAIN
CONTROL
BY
SAME
MEANS
AS
USED
IN
1ST
8
WEEKS.
*
IMPROVE
SHOULDER
MOTION
IN
ALL PLANE
*
IMPROVE
STRENGTH
AND
ENDURANCE
OF
ROTATOR
CUFF
AND
SCAPULAR
STABILIZERS.
MOTION:
FROZEN
SHOULDER
EXERCISES
*
ACTIVE
ASSISTED
EXERCISES.
*
PASSIVE
RANGE
OF
MOTION
EXERCISES
TO
OBTAIN
AROUND
140
DEGREE
OF
EXTERNAL
ROTATION
AND
INTERNAL
FORWARD
FLEXION,
45
DEGREE
OF
ROTATION.
1.
THERMOTHERAPY
DEEP
HEATING
MODALITIES
SUCH AS
SWD,
UST,
LWD
ETC.
USING
BEFORE
PASSIVE
MOBILIZATION
FOR
PROPER
RELAXATION
OF
MUSCLE &
LIGAMENT.
1.
GENERAL
MOBILIZATION
TECHNIQUE:-
*PASSIVE
GLIDING
WITH
LONGITUDINAL
TRACTION
:-
SUPINE,
FULL
ABDUCTION
AND
NEUTRAL
ROT.
WITH
ELBOW
IN
90°FL.
THERAPIST
APPLY
LONGITUDINAL
TRACTION
ALONG
THE AXIS
OF
THE HUMERUS, HE CARRIES
OUT AP
GLIDE
&
ABD.& ADD
GLIDE
IN A
SLOW
RHYTHMIC
MANNER. )
*
FORWARD
STOOPING
POSITING:-
STABILIZED
THE SH.
JT.
BY
ONE
HAND
&
OTHER
GRASP THE
WRIST
THEN
SLOW
CURCUMDUCTION
MOVEMENT
IS
CARRIED
OUT
UP
TO
LIMIT
OF
PAIN.
PASSIVE
MOBILIZATION
OF
SH. IN
A
FORWARD
STOOPING
POSITING
MUSCLE
STRENGTHENING
1.
START
WITH
ROTATOR
CUFF
STRENGTHENING
EXERCISES
3
TIMES/
WEEK,
8-12
REPETITIONS
FOR
THREE
SETS.
2.
CLOSED
CHAIN ISOMETRIC
STRENGTHENING
WITH THE
ELBOW
FLEXED
TO
90
DEGREES
AND
THE ARM
AT
THE
SIDE.
PERFORM
INTERNAL
ROTATION,
EXTERNAL
ROTATION,
ABDUCTION
AND
FORWARD
FLEXION.
3.
PROGRESS
TO
OPEN
CHAIN
STRENGTHENING
EXERCISES
WITH THERABAND
FOR
SAME
GROUP
OF MUSCLES.
4.
PROGRESS
TO
LIGHT WEIGHT
DUMBBELL
EXERCISES
FOR
INTERNAL
ROTATORS,
EXTERNAL
ROTATORS,
ABDUCTORS
AND
FORWARD
FLEXORS.
1.
STRENGTHENING
OF
SCAPULAR
STABILIZERS.
2.
DELTOID
STRENGTHENING
.
1.
LYING
DUMBBELL
PRESSES
PT.
LIE
ON SUPINE
LYING
HOLDING
A
LIGHT
DUMBBELL
IN
EACH
HAND.
EXTEND
YOUR
ARMS
VERTICALLY
WITH
PALMS
FACING
INWARDS.
NEXT,
PUSH
YOUR
ARMS
FURTHER
UPWARDS
KEEPING
THEM
PARALLEL
TO
EACH OTHER
SUCH
THAT
YOUR
SHOULDERS
BLADES
SEPARATE.
PERFORM
BETWEEN
10
AND
20
REPETITIONS
OF THE EXERCISE. INCREASE
THE
NUMBER
OF
REPETITIONS
WITH
PRACTICE.
2.
PUSH-UP
PLUS
HOLD
YOURSELF
IN
A
PUSH-UP
POSITION:
HERE,
YOUR
BODY
IS
HORIZONTAL,
FACING
DOWNWARDS,
ARMS
EXTENDED WITH
YOUR
SHOULDERS
WIDE
APART.
KEEP
YOUR
HEAD
IN A
STRAIGHT
LINE
WITH
YOUR
SPINE.
EXTEND
YOUR
SHOULDERS
TO
THE
FRONT
AND
SQUEEZE
YOUR
SHOULDER
BLADES
TO
BRING
YOURSELF
UP.
KEEPING
YOUR
ARMS
EXTENDED,
LET
GRAVITY BRING
YOU
BACK TO
THE
ORIGINAL
POSITION.
REPEAT
THE
WORKOUT
10-20
TIMES
DAILY.
3.
RHOMBOIDS
STRETCH
RHOMBOIDEUS
MAJOR
AND
MINOR
ARE
TWO
IMPORTANT
MUSCLES
TO
KEEP
THE
SHOULDER
GIRDLE
IN
A FUNCTIONAL
STATE.
FIRST
PLACE
YOUR
RIGHT
ARM
UNDER
YOUR
LEFT
SHOULDER
AND THEN
PLACE
YOUR
LEFT
ARM
OVER
YOUR
RIGHT
SHOULDER
AND FEEL
THE
STRETCH.
HOLD
THIS
POSITION
IN
10
SECONDS AND THEN RELAX.
PERFORM
10
REPETITIONS
FOR
EACH
ARM
TWICE
EACH
DAY.
7.
PENDULUM
EXERCISE
THE
PENDULUM
EXERCISE
IS
A
PART
OF
SCAPULAR
STABILIZATION
EXERCISEIS
GREAT
FOR
WORKING
A
LARGE
NUMBER
OF
MUSCLES
LIKE
THE
DELTOIDS,
SUBSCAPULARIS,
ROTATOR
CUFFS
AND
SUPRASPINATUS
AND
INFRASPINATUS
MUSCLES.
LEAN
ON
A
TABLE
PLACING
ONE
OF
YOUR
HANDS
ON
THE
TABLE
FOR
SUPPORT.
SWING
THE
OTHER
HAND
10-12
TIMES
BOTH
IN THE
BACKWARD-FORWARDS
DIRECTION AND
LATERALLY.
ALSO
SWING
THE
ARM
CLOCKWISE
AND
ANTI-
CLOCKWISE.
ANTERIOR
CAPSULE
STRETCHING
HAND
TO
BACK
POSITION:
TO
DECREASE
SHOULDER
STIFFNESS:-
GRAB
YOUR
AFFECTED
HAND
BEHIND
YOUR
BACK
AS
FAR
AS
POSSIBLE.
PUSH
THE HAND
DOWNWARDS
INTO
THE OPPOSITE
HAND
AND
HOLD
FOR
6
SECONDS.
RELAX
AND
SLOWLY
BRING
THE
HAND
BACK
UP.
REPEAT
2
TO
3
TIMES.
Hand
to
back
Sh.
Exe.
OTHER
EXERCISES
:
1.
WALL
&
LADDER
EXERCISES
EXERCISE.
2.
SHOULDER
&
WHEEL
EXERCISE
3.
FINGER
LADDER
EXERCISE.
Wall
&
l
a
d
d
er
e
x
e.
Periarthritis of the shoulder, also known as adhesive capsulitis or frozen shoulder, is a condition characterized by pain, stiffness, and limited range of motion in the shoulder joint. Risk factors include immobilization, tendon inflammation, stroke, lung disease, diabetes, and more. Clinical features include pain, limited mobility, and difficulty with daily activities. The condition progresses through stages of pain, stiffness, and recovery. Early diagnosis and appropriate treatment are essential for managing frozen shoulder effectively.
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Presentation Transcript
PERIARTHRITIS SHOULDER & ADHESIVE CAPSULITIS/FROZEN SHOULDER
DEFINITION:- 1. Peri-arthritis Is A Common Condition Characterised By Pain And Progressive Limitation Of Abduction & External Rotation Movement Of Shoulder Joint 1.FROZEN SHOULDER, ALSO CALLED ADHESIVE CAPSULITIS, CAUSES PAIN AND STIFFNESS IN THE SHOULDER. OVER TIME, THE SHOULDER BECOMES VERY HARD TO MOVE. 2.FROZEN SHOULDER OR ADHESIVE CAPSULITIS DESCRIBES THE COMMON SHOULDER CONDITION CHARACTERIZED BY PAINFUL AND LIMITED BOTH ACTIVE AND PASSIVE RANGE OF MOTION IN ALL PLAINS WITH RADIOGRAPHIC APPEARANCE.
Risk factors for frozen shoulder/PA include:- 1.Immobilisation Dueto Fracture & Dislocation The Shoulder Jt. 1. Bicipital Tendinitis 2. Rotator Cuff Tendinitis 3. Stroke, 4. Lung Disease, 5. RSD 6. Thyroid Disease ---- Hyperthyroidism 7. Heart Disease (CVS) -- Ischemic Heart Diseases 8. Diabetes Mellitus- insulin dependent diabetes 9. Tonic Seizures 10. Strain and Strain and Surgical trauma. Around
Clinical Feature YOU SHOULD BE ABLE TO MOVE YOUR SHOULDER IN ALL DIRECTIONS WITHOUT PAIN. TO TEST YOURSELF, DO THESE THINGS: SHOULDER STIFFNESS INABILITY TO RAISE ARM LIMITED SHOULDER MOBILITY SHOULDER PAIN SHOULDER IMMOBILITY RADIATING PAIN DOWN ARM SHOULDER PAIN; USUALLY A DULL, ACHING PAIN LIMITED MOVEMENT OF THE SHOULDER DIFFICULTY WITH ACTIVITIES SUCH AS BRUSHING HAIR, PUTTING ON SHIRTS/BRAS PAIN WHEN TRYING TO SLEEP ON THE AFFECTED SHOULDER 1. IN PA LIMITATION OF ABD. & ER OF GH JOINT. 2.PAIN FROM FROZEN SHOULDER & PA IS USUALLY DULL OR ACHING. IT IS TYPICALLY WORSE EARLY IN THE COURSE OF THE DISEASE AND WHEN YOU MOVE YOUR ARM. THE PAIN IS USUALLY LOCATED OVER THE OUTER SHOULDER AREA AND SOMETIMES THE UPPER ARM. 3. TENDERNESS FRONT OF SH. JT.
CLASSIFICATION OF F.A/A.C ADHESIVE CAPSULITIS IS CLASSICALLY CHARACTERISED BY THREE STAGE:- 1) FIRST STAGE (STAGE OF PAIN) ---- ( 3 TO 6 MONTH) 2) SECOND STAGE (STAGE OF STIFFNESS) ---(3 TO 18 MONTH) 3) THIRD STAGE (STAGE OF RECOVERY )-----(6 MONTH TO 2 YRS.) 1)FIRST STAGE (STAGE OF PAIN) IS THE FREEZING STAGE IS CHARACTERISED BY *ACHING PAIN IN SHOULDER *PAIN MORE SEVERE AT NIGHT WITH ACTIVITIES. *PAIN MAY RADIATES DOWN THE ARM * PATIENTS ADEPT THE ADDUCTION + INTERNAL ROTATION. * DISCOMFORT SHOULDER. NOTE:- (WHEN IT IS TREATED BY MOBILISATION THEN SYMPTOM BECOME WORSEN THE FREEZING PROCESS).
1)SECOND STAGE (STAGE OF STIFFNESS) IT IS ALSO CALLED FROZEN OR PROGRESSIVE STIFFNESS PHASE * PAIN DURING REST. *ADL SEVERELY RESTRICTED. * SHOULDER MOTION RESTRICTED IN ALL PLAIN. *PATIENT COMPLAIN:- 1 INABILITY TO REACH IN TO BACK POCKETS. 2 FASTEN THE BRA. 3 COMB THE HAIR. 4 WASH THE OPPOSIT SHOULDER. 5 PAI AT NIGHT. STAGE CAN BE LAST FROM 3 TO 18 MONTH ( NOT:- EASILY TREATED WITH MEDICINE AND PHYSICAL THERAPY.)
3) THIRD STAGE (STAGE OF RECOVERY )---- FINAL STAGE IS THROWING OR RESOLUTION PHASE. IT IS CHARACTERISED BY NO PAIN WITH SLOW RECOVERY OF MOTION. LOSS OF EXTERNAL ROTATION WITH ARM AT SIDE OF THE PT. IS HALLMARK OF THIS CONDITION. (NOTE:- AGGRESSIVE TREATMENT WITH PHYSICAL THERAPY AS CLOSE MANIPULATION AS MAITLAND & MULLIGAN ETC. IF CONSERVATIVE MANAGEMENT IS FAILED THAN SURGICAL RELEASE IS REQUIRED ).
DIAGNOSING OSTEOARTHRITIS:- 1. X RAY AP & LATERAL VIEW SHOULDER . 2. MRI SHOULDER 3. ORTHROSCOPY OF SHOULDER 4.ELEVATED ERYTHROCYTE SEDIMENTATION RATE [ESR] 5. C-REACTIVE PROTEIN [CRP] LEVEL) INCREASE 6. ANTI CYCLIC CITRULLINATED PEPTIDE [ANTI-CCP] 7.INFLAMMATORY JOINT FLUID WITH A PREDOMINANCE OF ....POLYMORPHONUCLEAR LEUKOCYTES (PMNS) 1. TLC & DLC , ELEVATED WHITE BLOOD CELL (WBC) COUNT
MANAGEMENT OF PA/FS DRUG MANAGEMENT 1.NSAID:- ASPIRIN, CELECOXIB (CELEBREX), DICLOFENAC POTASSIUM (CATAFLAM), DICLOFENAC SODIUM (VOLTAREN, VOLTAREN XR), DICLOFENAC SODIUM WITH MISOPROSTOL (ARTHROTEC), IBUPROFEN, INDOMETHACIN (INDOCIN, INDOCIN SR), OXAPROZIN (DAYPRO), PIROXICAM (FELDENE), ROFECOXIB (VIOXX) MEFENAMIC ACID (PONSTEL), MELOXICAM (MOBIC), NABUMETONE (RELAFEN), NAPROXEN (NAPROSYN, NAPRELAN), NAPROXEN SODIUM, KETOPROFEN
MANAGEMENT :- THE BASIC AIM OF FROZEN SHOULDER EXERCISES ARE: TO REDUCE PAIN. TO INCREASE EXTENSIBILITY OF THE THICKENED AND CONTRACTED CAPSULE OF THE JOINT. TO IMPROVE MOBILITY OF THE SHOULDER. TO IMPROVE STRENGTH OF THE MUSCLE. HOWEVER IT MAY BE REMEMBERED THAT STRENGTHENING OF MUSCLE IS SECONDARY TO MOBILIZATION.
MANAGEMENT OF PA/F. S. CLASSIFIED INTO THREE STAGE :- 1) FIRST STAGE (STAGE OF PAIN) ---- ( 3 TO 6 MONTH) 2) SECOND STAGE (STAGE OF STIFFNESS) ---(3 TO 18 MONTH) 3) THIRD STAGE (STAGE OF RECOVERY )-----(6 MONTH TO 2 YRS.) 1) FIRST STAGE (STAGE OF PAIN) ---- ( 3 TO 6 MONTH):- 1.NSAIDS- FIRST LINE MEDICATION FOR PAIN CONTROL ASSOCIATED WITH ANTACID. 2.GH JOINT INJECTION: CORTICOSTEROID/LOCAL ANESTHETIC COMBINATION. 3.ORAL STEROID TAPER- FOR PATIENTS WITH REFRACTIVE OR SYMPTOMATIC FROZEN SHOULDER. 4. THERAPEUTIC MODALITIES ICE FOR 20 MIN, ULTRASOUND 0.8 TO 1.2 WTTS. FOR 5 TO 7 MINS, HVGS FOR 25 MINS. APPLY MOIST HEAT BEFORE THERAPY AND ICE PACK AT THE END OF SESSION.
1.INITIALLY FOCUS ON FORWARD FLEXION AND INTERNAL AND EXTERNAL ROTATION WITH THE ARM AT THE SIDE, AND THE ELBOW AT 90 DEGREES. 2. ACTIVE ROM EXERCISES. 3.ACTIVE ASSISTED ROM EXERCISES. 4. PASSIVE ROM EXERCISES. 5.A SUSTAINED STRETCH, OF 15-30 SECONDS, AT THE END ROMS SHOULD BE PART OF ALL ROM ROUTINES. 6.IN HOME THESE FROZEN SHOULDER EXERCISES SHOULD BE PERFORMED 3-5 TIMES PER DAY. 2) SECOND & THIRD STAGE (STAGE OF STIFFNESS & STAGE OF RECOVERY ) --- CRITERIA FOR PROGRESSION TO STAGE - 2 IMPROVEMENT IN SHOULDER DISCOMFORT. IMPROVEMENT IN SHOULDER MOTION. SATISFACTORY PHYSICAL EXAMINATION.
GOALS * PAIN CONTROL BY SAME MEANS AS USED IN 1ST 8 WEEKS. * IMPROVE SHOULDER MOTION IN ALL PLANE *IMPROVE STRENGTH AND ENDURANCE OF ROTATOR CUFF AND SCAPULAR STABILIZERS. MOTION: FROZEN SHOULDER EXERCISES * ACTIVE ASSISTED EXERCISES. * PASSIVE RANGE OF MOTION EXERCISES TO OBTAIN FORWARD FLEXION, 45 DEGREE OF ROTATION. AROUND 140 DEGREE OF EXTERNAL ROTATION AND INTERNAL
1. THERMOTHERAPY DEEP HEATING MODALITIES SUCH AS SWD, UST, LWD ETC. USING BEFORE PASSIVE MOBILIZATION FOR PROPER RELAXATION OF MUSCLE & LIGAMENT. 1. GENERAL MOBILIZATION TECHNIQUE:- *PASSIVE GLIDING WITH LONGITUDINAL TRACTION :- SUPINE, FULL ABDUCTION AND NEUTRAL ROT. WITH ELBOW IN 90 FL. THERAPIST APPLY LONGITUDINAL TRACTION ALONG THE AXIS OF THE HUMERUS, HE CARRIES OUT AP GLIDE & ABD.& ADD GLIDE IN A SLOW RHYTHMIC MANNER. ) * FORWARD STOOPING POSITING:- STABILIZED THE SH. JT. BY ONE HAND & OTHER GRASP THE WRIST THEN SLOW CURCUMDUCTION MOVEMENT IS CARRIED OUT UP TO LIMIT OF PAIN.
PASSIVE MOBILIZATION OF SH. IN A FORWARD STOOPING POSITING
MUSCLE STRENGTHENING 1.START WITH ROTATOR CUFF STRENGTHENING EXERCISES 3 TIMES/ WEEK, 8-12 REPETITIONS FOR THREE SETS. 2.CLOSED CHAIN ISOMETRIC STRENGTHENING WITH THE ELBOW FLEXED TO 90 DEGREES AND THE ARM AT THE SIDE. PERFORM INTERNAL ROTATION, EXTERNAL ROTATION, ABDUCTION AND FORWARD FLEXION. 3.PROGRESS TO OPEN CHAIN STRENGTHENING EXERCISES WITH THERABAND FOR SAME GROUP OF MUSCLES. 4.PROGRESS TO LIGHT WEIGHT DUMBBELL EXERCISES FOR INTERNAL ROTATORS, EXTERNAL ROTATORS, ABDUCTORS AND FORWARD FLEXORS. 1.STRENGTHENING OF SCAPULAR STABILIZERS. 2. DELTOID STRENGTHENING.
1. LYING DUMBBELL PRESSES PT. LIE ON SUPINE LYING HOLDING A LIGHT DUMBBELL IN EACH HAND. EXTEND YOUR ARMS VERTICALLY WITH PALMS FACING INWARDS. NEXT, PUSH YOUR ARMS FURTHER UPWARDS KEEPING THEM PARALLEL TO EACH OTHER SUCH THAT YOUR SHOULDERS BLADES SEPARATE. PERFORM BETWEEN 10 AND 20 REPETITIONS OF THE EXERCISE. INCREASE THE NUMBER OF REPETITIONS WITH PRACTICE.
2. PUSH-UP PLUS HOLD YOURSELF IN A PUSH-UP POSITION: HERE, YOUR BODY IS HORIZONTAL, FACING DOWNWARDS, ARMS EXTENDED WITH YOUR SHOULDERS WIDE APART. KEEP YOUR HEAD IN A STRAIGHT LINE WITH YOUR SPINE. EXTEND YOUR SHOULDERS TO THE FRONT AND SQUEEZE YOUR SHOULDER BLADES TO BRING YOURSELF UP. KEEPING YOUR ARMS EXTENDED, LET GRAVITY BRING YOU BACK TO THE ORIGINAL POSITION. REPEAT THE WORKOUT 10-20 TIMES DAILY.
3. RHOMBOIDS STRETCH RHOMBOIDEUS MAJOR AND MINOR ARE TWO IMPORTANT MUSCLES TO KEEP THE SHOULDER GIRDLE IN A FUNCTIONAL STATE. FIRST PLACE YOUR RIGHT ARM UNDER YOUR LEFT SHOULDER AND THEN PLACE YOUR LEFT ARM OVER YOUR RIGHT SHOULDER AND FEEL THE STRETCH. HOLD THIS POSITION IN 10 SECONDS AND THEN RELAX. PERFORM 10 REPETITIONS FOR EACH ARM TWICE EACH DAY.
7.PENDULUM EXERCISE THE PENDULUM EXERCISE IS A PART OF SCAPULAR STABILIZATION EXERCISEIS GREAT FOR WORKING A LARGE NUMBER OF MUSCLES LIKE THE DELTOIDS, SUBSCAPULARIS, ROTATOR CUFFS AND SUPRASPINATUS AND INFRASPINATUS MUSCLES. LEAN ON A TABLE PLACING ONE OF YOUR HANDS ON THE TABLE FOR SUPPORT. SWING THE OTHER HAND 10-12 TIMES BOTH IN THE BACKWARD-FORWARDS DIRECTION AND LATERALLY. ALSO SWING THE ARM CLOCKWISE AND ANTI- CLOCKWISE.
HAND TO BACK POSITION: TO DECREASE SHOULDER STIFFNESS:- GRAB YOUR AFFECTED HAND BEHIND YOUR BACK AS FAR AS POSSIBLE. PUSH THE HAND DOWNWARDS INTO THE OPPOSITE HAND AND HOLD FOR 6 SECONDS. RELAX AND SLOWLY BRING THE HAND BACK UP. REPEAT 2 TO 3 TIMES. Hand to back Sh. Exe.
OTHER EXERCISES : 1. WALL & LADDER EXERCISES EXERCISE. 2. SHOULDER & WHEEL EXERCISE 3. FINGER LADDER EXERCISE. Wall & ladder exe.
