Ima

Advanced Physiotherapy Management to Restore The Functional Activities in Adhesive Capsulitis

Bio mechanics of shoulder The most mobile segment in body Highly plays with the functional activities of the distal joints with the positions providing functional base . Degrees of freedom when compared to shoulder it has 3degree of freedom

Movements of the shoulder  In congruent surfaces come in contact while the movement takes place  The humeral head has to glide in the gleniod fossa to improve its functional component  Unlike any other joint in body the mobility depends on ligaments and muscles equally

Movements 

Flexion & Extension – Posterior glide& Anterior glide with Scapular tucks

Abduction & Adduction – Inferior and Superior Glides (Abduction Paradox) 

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Rotation components – Int & Ext

Adhesive Capsulitis

Pre disposing factors      

Post traumatic Post CABG Mastectomy- post surgically Associated with C spine problems Geriatric DM

Definition Idiopathic restrictions in the shoulder range of motion characterized by pain with no bony or muscular lesion – WCPT (2006) [World Council Of Physical Therapy]

Classification

as recommended by the APTA [American Physical Therapy Association]

NEVASIER CLASSIFICATION

Stage

I

Description Pre adhesive stage with little or no restrictions

- 1962

II

III

IV

Acute synovitis with proliferative synovitis

Maturation phase – less synovitis which is demonstrate with loss of axillary fold of capsule

Chronic stage with fully mature adhesions with notable restriction of ROM

Classical complaints   

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Age – 35+ ref-JOSPT-II Vol- 2005 Sex – Male =Female Sides – dominant shoulder more affected Pain – dull aching radiating to the deltoid and lateral aspect of arm

On examination  

Loss of abduction paradox Restriction in a triad movements Forward Flexion Abduction External rotation

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Capsular tightness Arm swinging altered Donald lykes sign positive

Medical management   

NSAIDS STERIOD INJECTION MANUPULATION UNDER ANESTHESIA

PHYSIOTHERAPY (TRADITONAL MANGEMENT) HOT MODALITIES  PAIN INHIBITIERS- IFT/TENS  OVER HEAD EXERCISES USUALLY DOESENT HELP MUCH JUST A PAIN RELIEF AND A IMPROVEMENT OF JOINT RANGE TO JUST 10 TO 20 DEGRES 

What is the advanced management Mobilization ? therapy

Mobilization therapy 

Passive skilled manual therapy techniques applied to the joints and soft tissues at various speeds and amplitudes using physiologic or accessory movements for therapeutic purposes AMTA-1986

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Grade I -Small amplitude rhythmic oscillations are performed at the beginning of the range

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Grade II -Large amplitude rhythmic oscillations are performed at within the range not reaching the limit

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Grade III -Large amplitude rhythmic oscillations are performed up to the available ROM and are stressed into the tissue resistance

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Grade IV -Small amplitude rhythmic oscillations are performed at the limit of available motion and are stressed into the tissue resistance Grade V -A small amplitude high velocity thrust technique is performed to snap the adhesions at the limit of available range of motion

How does manipulation helps in adhesive capsulitis?

o

o

The ligamentous restrictions have to be broken and the intra articular synovial circulation has to be improved So any exercises which are advised for the patient will not work to regain the normal range of motion unless the capsule is free and cross bridges have to be broken

Technique of application Patient to be positioned in a supine position (abduction) and high sitting (flexion)shoulder abducted to 80 to 90 degree- slack position of capsule Then give a gentle traction Slowly perform the desired movement by mild oscillatory technique

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Positioning of the arm in – abduction and external rotation later changed to adduction with internal rotation in 30 minutes interval 3 to 4 sessions are done on the day and patient is discharged on same day evening and he gets a full ROM acitve For pain relief ice application is advised as home program and in during the admission hourly ice application – adv easy method and peripheral cooling inhibits the pain .

Out come Pre and Post scoring of the shoulder by SPADI – SHOULDER PAIN AND DISABLITY INDEX THE SCALE HAS GOOD RELIABLITY AND VALUBLITY – ref Australian journal of physiotherapy (consist of 8 components and 0 best score and worse is 80)

Home program     

Codman's pendular exercises Wand exercises Swimming Throwing exercises Plyometric exercises

Complication 

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By wrong positioning or over pressure Axillary nerve compression Post dislocation of shoulder

Advantages   

Single sitting Full range achieved Pain relief by local ice application