Adhesive Capsulitis Or Frozen Sholder.pptx

7/28/2019 Adhesive Capsulitis Or Frozen Sholder.pptx

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Adhesive Capsulitis OrFrozen Shoulder

MUHAMMED KOCABIYIK

PHYSICAL MEDICINE & REHABILITATION

IV. CLASS V. GROUP


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Definition The glenohumeral joint (ball and socket joint) is surrounded by a fibrous

capsule that is reinforced with several ligaments. This capsule/ligamentcomplex serves several functions:

1) keep the joint water tight; 2) provide support to help hold the ball in the socket at the end ranges of

shoulder motion;

3) provide sufficient volume to allow the shoulder to move through anincredibly wide range to position the hand in space.

When frozen shoulder syndrome occurs, this capsule becomes inflamed,

thickened and contracted. This process dramatically affects shouldermobility. The contracted capsule prematurely reaches maximal stretch beforethe shoulder reaches its normal end range of motion. As the capsulecontracture increases, shoulder motion decreases.

Certain types of frozen shoulder can also occur from scar tissue thatdevelops between the muscle layers of the shoulder joint and shoulder girdle.


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Causes

Idiopathic:This terms indicates that the cause is unknown.

Idiopathic cases account for the majority of patientspresenting with onset of shoulder stiffness.

Systemic Illness:Diabetes, hyperthyroidism (overactivethyroid), cardiovascular disease, lung disease, depression and

Parkinsons disease have all been associated with frozen shouldersyndrome. Diabetes has the most notable association and frozenshoulder may occur in roughly 15% of diabetic patients,particularly those who have been on insulin treatment forgreater than 10 years.


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Post-operative:Shoulder surgery for conditions such asrotator cuff tear, proximal humerus fracture, shoulderinstability and arthritis may result in stiffness due toaggressive scar formation during the healing process.Prolonged immobilization to protect a surgical repair maylead to stiffness. Frozen shoulder syndrome has also beenreported following neck surgery, open heart surgery, andradiation therapy for breast and lung cancer.

Post-traumatic:Shoulder or arm injury may result in afrozen shoulder from prolonged immobilization, scarformation during tissue healing or from a mechanical blockto movement as may occur if bony fractures heal in thewrong position.


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Risk Factors

Ageing - In Japan frozen shoulder syndrome is called "Fifties

Shoulder". Posture - especially round-shouldered

Shoulder-intensive sports

Shoulder intensive or repetitive manual occupation

Diabetes - Types I and II

Trauma

Immobilisation / splinting

Fracture of the collar bone or humerus (arm bone)

Surgery (especially after shoulder surgery, or mastectomy

with breast reconstruction)


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Stages of the Disease Inflammatory Phase:this initial phase occurs over 3

weeks to 3 months and is marked by relatively severe

shoulder pain. During this phase, the capsule becomesinflamed and the process of thickening and contracturebegin. Initially, pain predominates without significantstiffness, but gradual loss of motion ensues. Pain at restand night pain accompany pain with active use.

Freezing Phase:during this phase, shoulder motioncontinues to decrease until it approaches a minimumrange. Pain increases during this phase approaching aplateau. The time course of freezing is variable butgenerally lasts between 3 months and 9 months after

the onset of frozen shoulder.


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Frozen Phase:this phase is characterized by fixed loss ofmotion that does not increase or decrease. The shoulderremains uncomfortable during active use as well as atnight. Pain diminishes relative to the first two phases andis more manageable. The frozen phase also varies in

duration but may lasts between 6 months to a year.

Thawing Phase:Thawing is marked by gradual return inrange of motion and progressively decreasing pain. Theshoulder is no longer irritable. This phase generally begin

somewhere between 1-2 years after the onset of frozenshoulder.

Note: These phases apply only to idiopathic frozenshoulder and that which develops from systemic illness.They do not apply to post-operative and posttraumaticfrozen shoulder.


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Symptoms and Signs Symptoms:Progressively worsening pain without preceding injury is the

typical history of a frozen shoulder. Patients often think they have bursitisor a rotator cuff tear because the shoulder hurts with active use. Strength

is generally unaffected but limited by pain. Increasing difficulty with dailyactivities including dressing and hygiene are common complaints. Night painand pain that awakens patients from sleep is one of the most troublesomesymptoms. Some patients have pain that radiates into the neck, back orupper arm due to shoulder fatigue.

Signs:the physical exam of a frozen shoulder demonstrates loss of both

active and passive motion. This motion loss may be globally restricted in allranges or may be focally restricted in specific ranges. Loss of internalrotation (ability to put the hand behind the back) is usually the mostaffected. Strength testing generally indicates intact rotator cuff function.Rotation of the ball in the socket is smooth and without grating as occurs inarthritis.


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Diagnosis The diagnosis of frozen shoulder is usually made on the basis of your

medical history and physical examination. One key finding that helpsdifferentiate a frozen shoulder from a rotator cuff tear is how theshoulder moves. With frozen shoulder, the shoulder motion is the same

whether the patient or the doctor tries to move the arm. With a rotatorcuff tear, the patient cannot move the arm. But when someone else lifts thearm it can be moved in a nearly normal range of motion.

Simple X-rays are usually not helpful. An arthrogram may show that theshoulder capsule is scarred and tightened. The arthrogram involvesinjecting dye into the shoulder joint and taking several X-rays. In frozenshoulder, very little dye can be injected into the shoulder joint because thejoint capsule is stuck together, making it smaller than normal. The X-raystaken after injecting the dye will show very little dye in the joint.

Probably the most common test used is magnetic resonance imaging (MRI).An MRI scan is a special imaging test that uses magnetic waves to createpictures that show the tissues of the shoulder in slices.


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The MRI scan shows tendons and othersoft tissues as well as the bones. Colorized to illustrate softtissues revealed in MRI


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Treatment

Activity Modification: patients with frozen shoulder are

encouraged to remain active and use the affectedextremity. Activities which stress the shoulder andcause significantly worsening pain, however, mayincrease the inflammation in the shoulder capsule. Thisis particularly true in the inflammatory and freezingphases of the disease. Trying to work through the pain

is not recommended, and patients may have to modifytheir work and recreational activities until the painreaches a plateau.


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Physical Therapy: the goals of physical therapy are as follows:

1) gently stretch the shoulder to prevent worsening stiffness andimprove mobility;

2) decrease pain and inflammation through techniques such as

ultrasound and cold therapy; 3) gently strengthen the rotator cuff and shoulder girdle muscles

to prevent atrophy from disuse of the shoulder;

4) instruct patients on the proper techniques for a home exerciseprogram.

We generally recommend that patients attend a structuredphysical therapy program for about 6 weeks to accomplish thesegoals. Physical therapy may be most effective in the frozen phaseof the disease. Overly aggressive stretching during theinflammatory and freezing phases may actually worseninflammation and prolong the disease and patients should avoidtrying to work through the pain.


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Home Exercise Program: gentle stretching exercises shouldbe performed 2- 3 times daily to prevent adhesions fromreforming between therapy sessions. As much as possible,these sessions should be performed after the shoulder has

been relaxed by a hot shower, bath, or aerobic exercise.An important principle of the stretching exercises is toallow the muscles to relax so that the stretch can beapplied to the soft tissues without muscle interference.Tissues of a tight shoulder do not like to be stretchedsuddenly, roughly, or with a lot of force. Thus the strategy

is to apply a gentle stretch so that at most minimalsoreness results. Any soreness should go away within 15minutes after you stop the exercises. Improvement in therange of motion and comfort may not begin until six weeksof persistence with the program. One should not stopthese exercises until the frozen shoulder has regained

normal motion and comfort.


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Non-steroid Anti-inflammatory Medications (NSAIDS): thesemedications include Ibuprofen, Motrin, Advil, Naprosyn, Alleve,Bextra, Celebrex, and many others. They act both to reduceinflammation and to relieve pain. They may be more effective in

the early phases of frozen shoulder syndrome when theshoulder capsule is inflamed. Once the inflammatory processhas plateaued and patients reach the frozen phase, thesemedications are not likely to have significant benefit. Long termuse of NSAIDS may be associated with risks such as irritationof the stomach lining, ulcers and kidney problems. Patientsshould become informed about the possible short and long-termside effects of each medication prior to use.

Other Medications: Narcotic pain medications, muscle relaxantsand sleepingpills are generally not recommended for frozenshoulder syndrome as prolonged use may diminish theireffectiveness and may cause medication dependence or evenaddiction.


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Other non-operative treatments

Cortisone Injections: Cortisone is a powerful anti-inflammatorymedication that can be injected directly into the shoulder joint sothat it acts locally on the inflamed shoulder capsule. As with oralmedications, it may be most effective in the inflammatory andfreezing phases of the process which are dominated by inflammation.Occasionally, 2-3 shots spaced over several months may be necessaryto have an effect. The results of this treatment are variable and somepatients do not respond. Nevertheless, cortisone injections remain areasonable alternative in patients with moderate to severe discomfortwhose quality of life is significantly affected by the disease. Theinjections are generally well tolerated and have minimal sideeffects.In patients with diabetes, cortisone shots may temporarily elevate theblood sugar and careful glucose level monitoring is recommended forthe first few days after treatment.


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Nerve Blocks: the suprascapular nerve supplies sensation to theshoulder capsule. There is growing evidence that blocking this nervewith a series of injections may help alleviate some of the discomfort offrozen shoulder. These injections are performed by theanesthesiologists who use a device called a nerve stimulator to targetthe injection into the proper location. Nerve blocks are not a cure for

frozen shoulder. Rather, their purpose is to reduce the effect ofshoulder discomfort on the patients quality of life and facilitate a homeexercise program.

Acupuncture: This is an ancient medicinal art that uses needles insertedinto the body at points along the meridians just under the skin. Theseneedles stimulate, disperse and balance the flow of energy, relieve pain,and treat a variety of chronic, acute and degenerative conditions. Thereis anecdotal evidence that acupuncture may be helpful in managing thepain associated with frozen shoulder. As with most other treatments,however, acupuncture is not a cure and does not necessarily shorten thecourse of the disease.

Surgery may be considered if a concerted effort at non-operativetreatment has failed to result in improvement in comfort andfunction after 6-9 months.


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Exercises for Frozen Sholder


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THANK YOU

Adhesive Capsulitis Or Frozen Sholder.pptx

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