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Frozen Shoulder Physiotherapy Management
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- 2. Introduction • It isa clinical syndrome characterized with painful restriction of both active and passive shoulder movements
- 3. Medical Management • Corticosteroidinjections are often used to manage inflammation as it is understood that inflammation is a key factor in the early stages of the conditio Methyl-prednisolonee and Triamicinolone • Non-steroidal anti-inflammatory drugs (NSAIDs)have traditionally been given to patients with adhesive capsulitis. Ibuprofen Naproxen
- 4. • Oral steroidshave also been utilised in these patients and result in some improvement in function, but their effects have not shown long term benefits and combined with their known adverse side effects
- 5. • Manipulation underanaesthesia Manipulation under anesthesia involves a controlled and forced, end range positioning of the humerus relative to the glenoid in physiologic planes of motion in patients with an anesthetic block to the brachial plexus
- 6. • Translation Mobilizationunder anaesthesia This dureedure involves the use of gliding techniques with static end range capsular stress with a short amplitude high velocity thrust, if needed, as opposed to the angular stretching forces in manipulation under anesthesia.
- 7. Surgical Management • Arthroscopiccapsular release Arthroscopic capsular release is the preferred method over open release in patients with painful, disabling adhesive capsulitis that is unresponsive to at least 6 months of non-operative treatment
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- 9. Short term goals 1.Patient and family education 2. Reduce pain 3. Improve range of motion 4. Improve muscle strength
- 10. Long term goals 1.Maintain Range of motion 2. Maintain muscle strength 3. To make the patient functionally independent to perform his ADL 4. Ergonomic Advice 5. Home program
- 11. Patient and Familyeducation • For the treatment of adhesive capsulitis, patient education is essential in helping to reduce frustration and encourage compliance. • . It is also helpful to give quality instructions to the patient and create an appropriate home exercise program that is easy to comply with as daily exercise is critical in relieving symptoms.
- 12. To reduce pain •Ultrasound – continuous mode • Chronic conditions initially 0.8 Wcm2 For 4 mins • Hot pack – muscle relaxation • Maitland Mobilization grade I and II
- 13. To improve rangeof motion • Passive Range of motion exercise • Mobilization • Active assisted Exercise • Active Exercise • Stretching • Aquatic therapy
- 15. • Mobilization Maitland Mobilization Posteriorglide to improve flexion range Inferior glide to improve Abduction range Maitland mobilization grade I and II for pain relief grade III and IV to improve ROM
- 16. Stretching to increase shoulderflexion with elevation
- 17. • To increaseexternal rotation
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- 19. • Wand exercise •FLEXION
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- 22. Internal and externalrotation
- 23. To improve musclestrength • Isometrics • Isometrics at different Angles
- 24. Rotator cuff strengthening- threetimes per week, 8 to 12 repetitions for three sets • Closed-chain isometric strengthening with the elbow flexed to 90 degrees and the arm at the side.
- 25. • Progress toopen-chain strengthening with Therabands,Weight cuff,Sand bags,springs • Theraband exercises permit concentric and eccentric strengthening of the shoulder muscles and are a form of isotonic exercises (characterized by variable speed and fixed resistance)
- 26. • Progress tolight isotonic dumbbell exercises • Internal rotation. • External rotation
- 27. Strengthening of scapularstabilizers • Closed-chain strengthening exercises • Scapular retraction (rhomboideus, middle trapezius). • Scapular protraction (serratus anterior) • Scapular depression (latissimus dorsi, trapezius, serratus anterior). • Shoulder shrugs (trapezius, levator scapulae).
- 28. • Progress toopen-chain strengthening
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- 32. • Progressing toopen chain strengthening • Progressive resisted exercise . Delorme protocol
- 33. Home program • Pendularexercise • Wall exercise • Aquatic therapy • Wand exercise • Press ball againts wall • Writing on board
- 34. Ergonomic advice • Dependingupon the occupation of the patient
- 35. • Advice 1. Avoidjerky movement or stretching 2. Avoid lifting heavy weights 3. Avoid Hand shakes 4. Avoid any impact
- 38. REFRENCE • Clinical OrthopaedicRehabilitation-Dr. S. Brent Brotzman and Robert C. Manske • Therapeutic Exercise Foundations And Techniques-Carolyn Kisner Lynn Allen Colby