Shoulder Unit- Frozen Shoulder Flashcards
Frozen shoulder:
an umbrella term for a stiff and painful shoulder
Other terms used:
- *Adhesive capsulitis
- Periarthritis
- Shoulder-hand syndrome
- Duplay’s syndrome
How is adhesive capsulitis characterized?
-characterized by inflammation and fibrotic thickening of the anterior joint capsule of the shoulder
>Inflammation causes fibrous adhesions to form and capsule thickens
-characterized by the symptoms of limitation in glenohumeral motion and pain
What happens when the capsule is inflamed?
-capsule becomes adherent to the humeral head and undergoes contracture
>Decreased space within the capsule leads to decrease of synovial fluid and further irritation to glenohumeral joint
when it’s a secondary condition it is the result of?
-result of trauma, inflammation or an underlying condition
>The resulting stiffness can be due to soft tissue problems in the shoulder itself, or from an injury that is more distal
ex: Trauma, immobilization, RSD, RA, suprspinatus tendonitis, partial RTC tear, bicipital tendonitis
It is presented clinically by:
-Passive and active range of motion limitations in a capsular pattern
-Severely restricted function
>Greatest restriction in abduction and ER but all planes affected
>Tightness in anterior-inferior joint capsule
-Pain with stretching
-Muscle spasms secondary to muscle guarding
-Disuse atrophy
Diagnostics: Arthrogram
-To detect decreased volume of fluid in joint capsule
>Usually holds 16-20 ml of fluid but with frozen shoulder have decrease in size of the capsule so holds 5-10 ml of fluid
Outcomes:
-Self-limiting condition in which the shoulder goes through a cycle of “freezing”, “frozen” and “thawing”
-Duration of each phase varies from person to person
>Nonlinear patterns of recovery
When does recovery happen?
-Spontaneous recovery occurs within 1-3 years
>Most patient fully recover with 7-14% experiencing permanent loss of ROM at shoulder joint which is asymptomatic and does not affect function
Positioning for Frozen shoulder
-Encourage patients to avoid the adducted, internally rotated shoulder position
>Do not permit the patients to wear slings unless necessary to protect a surgical repair
>Encourage the patient to sleep supine with a pillow under the affected arm in slight abduction and in the plane of the scapula
Conservative-Stage 1 “Freezing”
- painful phase
- Goals = pain control, maintain ROM
- Patient presents with pain that radiates below the elbow and awakens them at night
- PROM limited secondary to pain and guarding
-isometrics
Conservative-Stage 1 “Freezing”
Pain control
Modalities
For inflammation
For pain
TENS
Conservative-Stage 1 “Freezing”
PROM
-Within pain free range to minimize soft tissue inflammation
>Pulleys or wands
-AAROM - AROM as pain begins to subside and done in pain free range
>Monitor for substitutions
> Joint mobilization- grade I or II
Conservative-Stage 2 “Frozen”
- stiff phase
- Goals- increase ROM, increase functional use
-Pain is localize around the lateral brachial region
>Pain does not awaken the patient
-PROM limited secondary to capsular stiffness
-Loss of GH motion
>Restricted elevation and ER
Conservative-Stage 2 “Frozen”
ROM
-AROM and PROM exercises
-Joint mobilization – III or IV
-Stretching
>Techniques that use low load prolonged stretch are beneficial
»_space;Weights, pulleys, rubber tubing, gravity assistance
-Strengthening
-Posture correction
Conservative-Stage 3 “Thawing”
Goals – increase end ROM, increase strength
