Shoulder Mobility Deficit Flashcards
What will you typically hear in the History, with a patient with a Shoulder Mobility Deficit?
- It was an Insidious Onset
- “Stiffness” and pain; worsens over time
What are the Agg and Ease Factors?
Agg:
- Prolonged Positioning
- End-Range shoulder motions
Ease:
- Movement
What is the 24hr behavior?
Pain is the worse in the morning
During the Physical Examination, what may you find in shoulder ROM?
AROM and PROM are limited; Potential capsular pattern
During the Physical Examination, what may you find in the Joint Integrity and Mobility Assessment?
Hypomobility
During the Physical Examination, what may you find in the Muscle Performance Testing?
Potential Decreased Muscle Length
With the shoulder, what are 4 condition that may cause shoulder mobility deficit?
- Adhesive Capsulitis
- Calcific Tendinopathy
- Acromioclavicular Joint Pathology
- Glenohumeral Osteoarthritis
What are Primary and Secondary causes of Adhesive Capsulitis?
Primary: Etiology unknown (Idopathic)
Secondary: Trauma, surgery, associated with an underlying condtion such as Clacific teninosis or RC pathology, or prolonged immobilization
What is Adhesive Capsulitis?
Synovial inflammation with subsequent reactive capsular fibrosis
Making this both an inflammatory and a fibrosis condition, depending on the stage of the disease
What may you find in the Hx of those patients with Adhesive Capsulitis? What are the risk factors
- Typically female
- >40 years old (40-65)
- Has Endocrine disorder:Diabetes, Thyroid disease
- Had Adhesive Capsulitis on contralateral arm
- Low BMI
- Presence of immune disease
- CVA or MI
- Certain psychiatric disorders
The ones in bold are also RISK FACTORS
What are the 3 stages of Adhesive Capsulitis?
Freezing, Frozen, Thawing
Initially (before the 3 stages), Adhesive Capsulitis present with mild s/s often mimic impingment syndrome and are characterized by progressive stiffness, restriction of ROM and pain generally becomes severe and disabling
What are common exam finding with Adhesive Capsulitis?
- Motion is loss is a capsular pattern in all planes
- Painful and limited AROM and PROM of shoulder elevation usually <120°
- Passive ER of 50% or <30°
- No definitive diagnostic tests
- Decreased joint mobility
Adhesive Capsulitis (Frozen Shoulder Contracture Syndrome)
How is FSCS characterized in the Freezing stage?
- Persistent and more intense pain, even at rest
- Night pain and disturbed sleep occur during acute flares
- Loss of ROM in all planes and there is pain throughout the range
- Typically demonstrate an inability to reach overhead, behind the head, and behind the back. This results in difficulty with dressing, self-grooming, bringing eating utensils to mouth and reaching the hand into the back pockets
The motion loss in this stage reflects loss of capsular volume and a response to painful synovitis
Patient with Adhesive Capsulities, what will you find with AROM/PROM
- There is normally decreased joint play associated with limited ER and Abduction, some some IR limitatons.
Adhesive Capsulitis (Frozen Shoulder Contracture Syndrome)
How is FSCS characterized in the Thawing stage?
- Slow, steady recovery of some of the lost ROM resulting from capsular remodeling in response to the use of the arm and shoulder
What are the objective finding when FSCS is in the Thawing stage?
- Stiff shoulder
- Marked alteration of scapulohumeral mechanics
- limited arm use during ADLs
Tissue resistance in the form of a capsular EF is felt before pain is reached as the GH joint is taken through ROM
What is the Prognosis for Adhesive Capsulitis?
Adhesive capsulitis occurs as a continuum of pathology characterized by a staged progression of pain and mobility deficits and that, at 12 to 18 months, mild to
moderate mobility deficits and pain may persist, though many patients report minimal to no disability
However the gradual return to full mobility occurs within 18 months to 3 years, even without specific intervention
What should you do for Interventions with patients with Adhesive Capsulitis for short term relief and function?
CSIs along with shoulder mobility and stretching exercises have been found to be effective in providing short term (4-6 weeks) pain relief and improved function
Adhesive Capsulitis
As a general guideline, what interventions should you do
if the patient presents with capsular restriction and low irritibility compared if they had high irritability?
With low irritability they may require aggressive soft tissue and joint mobilization
With high irritability they may require pain-easing manual therapy techniques
Adhesive Capsulitis
What can be done in the Acute stage for those patients with Adhesive Capsulitis?
Pendulum exercises and low grade joint mobilizations techniques are recommended to relieve pain and apply a gentle stretch to the capsule.
- Also the clinician can perform passive stretching of the Upper trap., and Levator Scap. then teach the patient a part of the HEP
Adhesive Capsulitis
What can be done in the Subacute stage for those patients with Adhesive Capsulitis?
More aggresive ROM exercises can be incorporated using PNF techniques, wall climbing, and wall/corner stretches
Adhesive Capsulitis
What can be done in the Chonic stage for those patients with Adhesive Capsulitis?
As ROM returns, strength becomes the focus, initiating isometric and then progressive strengthening of the shoulder complex
What is Calcific Tendinopathy?
This is characterized by a reactive calcification that affects the RTC tendons with associated acute or chronic painful shoulder ROM restrictions impacting ADLs. (Typically affects the Suprasinatus)
- The course of the disease may be cyclic (occurs in cycles), with spontaneous resorption and and reconstitution of the tendon
What population does Calcific Tendinopathy typically affect?
More common in caucasian females between 30-50 years of age
