The shoulder is made up of three castanetss: the collarbone ( clavicle ) . the shoulder blade ( shoulder blade ) . and the humerus ( upper arm bone ) every bit good as associated musculuss. ligaments and sinews. The articulations between the castanetss of the shoulder make up the shoulder articulations. The joint pit is cushioned by articular gristle covering the caput of the humerus and face of the glenoid. The joint is stabilized by a ring of hempen gristle environing the glenoid called the labrum.

Four short musculuss originate on the shoulder blade and base on balls around the shoulder where their sinews fuse together to organize the rotator turnup. Two bursae shock absorber and protect the rotator turnup from the bony arch of the acromial process and let smooth motion of the joint- subacromial Bursa and subdeltoid Bursa.

Joints OF THE SHOULDER
There are 3 articulations of the shoulder-
Glenohumeral articulation
Acromioclavicular articulation
Sternoclavicular articulation



CAPSULE OF THE SHOULDER JOINT LIGAMENTS OF THE SHOLDER JOINT

Motions OF THE SHOULDER
1. Abduction: 150 grades
2. Adduction: 150-0 grades
3. Forward flexure: 180 grades
4. Extension: 45-60 grades
5. Rotation ( trial with cubitus flexed to 90 grades )
1. External Rotation: 90 grades
2. Internal rotary motion: 70-90 grades






DEFINITION OF FROZEN SHOULDER
Frozen shoulder. medically referred to as adhesive capsulitis. is a upset in which the shoulder capsule. the connective tissue environing the glenohumeral articulation of the shoulder. becomes inflamed and stiff. and grows together with unnatural sets of tissue. called adhesions. greatly curtailing gesture and doing chronic hurting. A frozen shoulder is a shoulder articulation with important loss of its scope of gesture in all waies. The scope of gesture is limited non merely when the patient attempts gesture. but besides when the physician attempts to travel the joint to the full while the patient relaxes. Frozen shoulder is defined as a clinical syndrome characterised by painful limitation of both active and inactive shoulder motions due to causes within the shoulder articulation or remote ( other parts of the organic structure ) . • Frozen shoulder is the consequence of marking. inspissating. and shrinking of the joint capsule. • Hazard FACTORS

• Frozen shoulder occurs much more normally in persons with diabetes. impacting 10 % to 20 % of these persons. Other medical jobs associated with increased hazard of frozen shoulder include: hypothyroidism. thyrotoxicosis. Parkinson’s disease. and cardiac disease or surgery. •

CAUSES OF FROZEN SHOULDER
Most instances of frozen shoulder are idiopathic ( Primary frozen shoulder ) . but some possibly associated with certain factors such as diabetes mellitus. spinal lesions. injury or drawn-out immobilization of the shoulder for some other cause ( Secondary frozen shoulder ) . Any hurt to the shoulder can take to frozen shoulder. including tendonitis. bursitis. and rotator cuff hurt. Frozen shoulders occur more often in patients with diabetes. chronic inflammatory arthritis of the shoulder. or after chest or chest surgery. Long-run stationariness of the shoulder articulation can set people at hazard to develop a frozen shoulder. It is recognised that frozen shoulder follows a definite sequence that occurs in three chief phases. These have been described by Cyriax as follows: Phase 1 ( phase of hurting ) : patient complains of ague hurting. decreased by motions. external rotary motion greatest followed by loss of abduction and so frontward flexure. Internal rotary motion is to the lowest degree affected. This phase last for 10-36weeks. Phase 2 ( phase of stiffness ) : Here. trouble bit by bit lessenings and the patient complains of stiff shoulder. Little motions are present. Phase 3 ( phase of recovery ) : patient will hold no hurting and motions will hold recovered but will ne’er be regained to normal. It lasts for 6months to 2years.

ASSESSMENT OF A PATIENT WITH FROZEN SHOULDER
DEMOGRAPHIC DATA
Name. age. gender. business. socio economic position
Chief complaints-patient ailments of hurting in the shoulder and inability to travel the shoulder after a certain scope. History
Past history- h/o DM or HTN
Family history-h/o DM or HTN
Present history-cause of hurting. oncoming of hurting. continuance of hurting. Observation
Build of the patient- Endomorphic/ectomorphic / mesomorphic
Position of the patient/Attitude of the limbs
Scope of Motion- comparison both the limbs ROM for any divergence in both Active and Passive motions.








Motions RIGHT LEFT Flexion
Extension
Abduction
Adduction
Internal rotary motion
External rotary motion
PALPATION/PERCUSSION
No focal point of tenderness.
Trial AND Examination







Active trial of ROM with little overpressure at the terminal point of each motion. This trial will uncover definite capsular limitation of the glenohumeral articulation. The motions chiefly involved are external rotary motion and abduction. No evident muscular failing will be present in the available ROM. but overpressure at the terminal of the scope will arouse hurting. Active resisted trial of ROM. At the initial scope normally there is no hurting. nevertheless. considerable opposition possibly painful. Passive trial of ROM. With patient in supine place it is of import to corroborate the capsular form of limitation of the joint and the diagnosing of adhesive capsulitis. Laboratory and Radiographic trials:

Blood trial: Blood trials can assist the physician expression for other medical ailments that may be doing shoulder hurting e. g. diabetes. underlying arthritis. X ray: of cervix to look into for arthritis or spondylosis in the articulations. X ray of shoulder itself might demo Ca in the musculuss or arthritis of the shoulder. If particular dice is injected prior to the X ray or scan so the trial is known as an “arthrogram” . Ultrasound scan: An ultrasound scan is a really utile trial for measuring a patient with shoulder hurting. These scans are first-class at analyzing the musculuss and sinews around the shoulder and will let the physician to observe an inflamed or lacerate musculus. MRI Scan: utile for placing pathology in soft tissues around shoulder articulation.

MANAGEMENT OF PATIENT WITH FROZEN SHOULDER
Management of this upset focuses on reconstructing joint motion and cut downing shoulder hurting. Conservative direction
Medications- Injection with steroids ( NSAIDS ) e. g. methylprednisolone. Cortone Acetate. Treatment may be needed for several months. Injections are normally given under radiological counsel. with either fluoroscopy. ultrasound or Computed Tomography ( CT ) . Radiological counsel is utilized so that the acerate leaf is safely and accurately guided into the shoulder articulation. Surgical-aimed at stretching or let go ofing the contracted joint capsule of the shoulder Arthroscopy-to cut the adhesions ( capsular release ) may be indicated in drawn-out and terrible instances. Manipulation under anesthesia involves seting the patient to kip and “manipulating” or coercing the shoulder to travel. This procedure causes the capsule to stretch or rupture. Nutrition

PHYSIOTHERAPY MANAGEMENT OF FROZEN SHOULDER
Physical therapy in FS

Renewing methods Preventive methods Relaxation. mobilization methods Early sensing and thermotherapy Early mobilization By physical therapist By patient himself Avoid quacks Passive mobilization Home government

Health instruction
STAGE 1- In this phase long moving one time a twenty-four hours NSAIDs are normally preferred as this status normally runs a long class ( 10-36weeks ) . Intra-articular steroids may be helpful STAGE 2 and 3- Shoulder mobilization and strengthening of musculuss needed to convey about these motions. SHOULDER MOBILISATION TECHNIQUES

Attempts are targeted at softening this capsule by inactive mobilization. Role of the physical therapists
Thermotherapy- before fall backing to thermotherapy. the midst and contracted capsules can be relaxed and made more stretchy by deep warming utilizing ultrasound or other modes. The warming is carried out all around the shoulder with a particular focal point on the antero-inferior boundary line of the armpit where the basic defect is said to be. Passive mobilization techniques- after thermotherapy the followers is done In the forward stoop place. In this place the physical therapist stabilizes the shoulder articulation with one manus and hold on the carpus with the other manus. A slow rhythmic circumduction motion is carried out upto the bound of hurting. In the supine place. Here patient is supine and the shoulder is in the place of maximal abduction. impersonal rotary motion with the cubitus in 90degree of flexure. The physical therapists now grasps the arm with his manus and using longitudinal grip along the axis of the humerus. he carries out an antero-posterior semivowel and an abduction and adduction semivowel in a slow rhythmic mode. Role of patient

The undermentioned steps are suggested to the patient to be carried out at place at frequent intervals: Pendulum Exercises- in a forward stoop place. with one manus resting on the tabular array or chair. the patient bit by bit swings his arm like a pendulum and subsequently carries out a circumduction motion. Shoulder elevation- with the normal manus back uping the affected 1. the shoulder is bit by bit lifted up in a place of flexure. abduction and external rotary motion. Hand to endorse position- Here the patient carries the affected arm backwards with the shoulder in a place of extension. adduction and internal rotary motion with the cubitus in 90degree flexure. Self stretch- Using the normal arm the patient is instructed to stretch limb bit by bit and sporadically. Other steps

a ) Shoulder wheel exercisings
B ) Pulley exercisings
degree Celsiuss ) Wall mounting exercises/finger ladder
PREVENTIVE MEASURES
1. Early sensings
2. high hazard patients




MOBILIZATION TECHNIQUES FOR SHOULDER JOINT WITH ADHESIVE CAPSULITIS Mobilization is a curative motion of the joint. It’s a back-and-forth oscillating motion done within the available joint scope of gesture. And it’s done by the physical healer at a velocity the patient can command. They are inactive. skilled manual therapy techniques applied to articulations and related soft tissues at changing velocities and amplitude utilizing physiologic or accessary gestures for curative intent. USES-Mobilization can be used to stretch the shoulder capsule and soft tissues. GOAL-The end is to reconstruct normal joint gesture and beat. Indication

Pain. musculus guarding and cramp
Reverse joint hypomobility
positional faults/subluxation
Progressive restrictions
Functional stationariness
Contraindication
Hypermobility
Joint gush
Inflammation







Mid-range mobilisation ( MRM ) . end-range mobilisation ( ERM ) . and mobilisation with motion ( MWM ) techniques have been advocated by Maitland. Kaltenborn and Mulligan. MRM-With the topic in a relaxed supine place. the humerus was moved to the resting place ( 40° of abduction ) . While the humerus was held in this place. 10 to 15 repeats of the mobilisation techniques were applied. ERM-The purpose of ERM was non merely to reconstruct joint drama but besides to stretch contracted periarticular constructions. The physical healer examined the subject’s ROM to obtain information about the end-range place and the end-feel of the glenohumeral articulation. Then. the therapist’s custodies were placed near to the glenohumeral articulation. and the humerus was brought into a place of maximum scope in different waies. Ten to 15 repeats of intensive mobilisation techniques. changing the plane of lift or changing the grade of rotary motion in the end-range place. were applied.

MWM-This technique combines a sustained application of a manual technique “gliding” force to a joint with coincident physiologic ( osteo-kinematic ) gesture of the joint. either actively performed by the topic or passively performed by the healer. The manual force. or mobilisation. is theoretically intended to do repositioning of bone positional mistakes. The purpose of MWM is to reconstruct unpainful gesture at articulations that have painful restriction of scope of motion. With the topic in a relaxed sitting place. a belt was placed around the caput of the humerus to glide the humerus caput suitably. as the therapist’s manus was used over the appropriate facet of the caput of the humerus. A counter force per unit area besides was applied to the shoulder blade with the therapist’s other manus. The semivowel was sustained during slow active shoulder motions to the terminal of the unpainful scope and released after return to the get downing place. Three sets of 10 repeats were applied. with 1 minute between sets.

TISSUE RESISTANT ANATOMIC LIMIT Diagrammatic representation of ranked oscillation techniques ( adapted from Maitland ) Grade I. Small amplitude rhythmic oscillations at the beginning of scope. Grade II. Large amplitude rhythmic oscillations within the scope. non making bound. Grade III. Large amplitude rhythmic oscillations upto the bound of available gesture and stressed into tissue opposition. Grade IV. Small amplitude rhythmic oscillations at the bound of available gesture and stressed into tissue opposition. Grade V. Small amplitude high speed push technique to snarl adhesions at the bound of available gesture.

TISSUE RESISTANCE ANATOMIC LIMIT Diagrammatic representation of sustained translatory joint drama techniques ( adapted from Kaltenborn ) Grade I. ( loosen ) little amplitude distraction is applied where no emphasis is placed on the capsule. Grade II. ( Tighten ) adequate distraction or semivowel is applied to fasten the tissues around the joint. Grade III. ( Stretch ) distraction or semivowel is applied with amplitude big plenty to put a stretch on the joint capsule and on environing periarticular constructions.

Bibliography

Necessities of Orthopedicss for Physiotherapists-John Ebenezer Therapeutic Exercise- Carolyn Kisner and Lynn Allen Colby
Internet

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