PATIENTS GUIDE TO ADHESIVE CAPSULITIS(FROZEN SHOULDER)

WHAT IS FROZEN SHOULDER?

Frozen shoulder results from the gradual loss of movement in the shoulder joint.the joint consists of a ball and socket. Normally,it is one of the most mobile joints in the body.when the shoulder becomes frozen,the joint has become stuck and its movement is limited.

SIGNS AND SYMPTOMS

  • Decreased shoulder range of motion.
  • Reduced arm swing while walking.
  • Pain and stiffness around the shoulder joint.
  • Increased shoulder pain during night.
  • Difficulty in performing basic activities such as dressing,answering the phone,grooming,and hands behind back movements.
  • Frozen shoulder has three distinct stages of progression. Early stage typically takes months to progress. The normal progression of frozen shoulder through all three stages is between six months and two years. Without a purposeful effort to restore motion,the effects of a frozen shoulder may become permanent.

THE THREE STAGES OF FROZEN SHOULDER PROGRESSION

PAINFUL STAGE(FREEZING STAGE) Shoulder pain is the hallmark of this stage.it starts gradually and progressively worsens.
FROZEN STAGE Pain may reduce in this stage,although shoulder stiffness and restriction increases. Shoulder range of motion is dramatically reduced.
THAWING STAGE This stage is characterized by spontaneous thawing. The motion will gradually increase and the shoulder will be more responsive to stretching exercises and treatment.
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RISK FACTORS

  • Most common in females between the age group of 40-60 years.
  • Diabetes
  • Immobilization of shoulder
  • high blood pressure
  • Hyperparathyroidism
  • Inflammation or autoimmune reaction.
  • Post stroke
  • Parkinson’s disease

TREATMENT OPTIONS FOR FROZEN SHOULDER

The most fundamental component of treating frozen shoulder is movement. The most common treatments for frozen shoulders are mobility exercises and anti-inflammatory drugs. In rare cases,manipulation under anesthesia(MUA) or surgery may be indicated. INTERVENTIONAL PROCEDURES

INTERVENTIONAL PROCEDURES

In the event that more conservative measures do not work, more intrusive treatments can be employed. These interventions include steroidal injections, MUA and surgery. Steroid injections appear to be as effective as MUA but have less of dangers associated with anesthesia and sedation. Surgery is usually reserved for more resistant cases of adhesive capsulitis. In MUA,the patient is sedated to reduce the level of pain and muscle resistance. The orthopedic surgeon manipulates the shoulder to break free the adhesions.an intensive regime of physical therapy is required for a couple weeks following MUA to prevent new adhesions from forming following the manipulation.

ContraindicationsforMUAincludes

  • Insulin dependent diabetes.
  • Those with bleeding disorders.
  • Patients with risk to anesthesia.

SURGERY

In cases that are resistant to all other forms of treatment arthroscopic surgery may be utilized to remove the restrictive adhesions.

REHABILITATION

Shoulder motion is the primary treatment for frozen shoulder.it is important to continue to use the arm as much as tolerated while healing. If the shoulder is overly protected from motion the condition will worsen. The exercise program that follows is intended to increase motion in all planes of shoulder motion.
Remember that healing from a frozen shoulder will take time. These exercises need to be done every day.

SHOULDER PENDULUM


  • Begin using weight of your arm without any added weights, gradually incorporating light dumbbells into the routine.
  • The frozen shoulder arm follows the body’s motion. Keep back straight,core tight,feet shoulder width apart.
  • Support opposite arm to allow the affected arm to hang straight down with full relaxation of that shoulder’s muscles.
  • Using the motion of your body to create shoulder motion,sway your body.start with small circles to gradually increasing to larger circles. Also perform to and from movement from front and back aswell as medial and lateral. Repeat each set for 10 times.

CANE EXERCISES

Initiate active assisted range of motion using a cane in the lying position to provide stabilization and control of scapula. Motions usually included are flexion(movement in frontal plane),abduction(movement sideways) and rotations.

MUSCLE SETTING EXERCISES

Gently contract a group of muscles while slight resistance is applied-just enough to stimulate a muscle contraction without provoking pain.

STRETCHING EXERCISES

Manual stretching techniques are used to increase mobility in shortened muscles and related connective tissues.As the joint reaction becomes predictable and the patient begins to tolerate stretching, self-stretching techniques are taught.

JOINT MOBILIZATION TECHNIQUES

  • Passive joint distraction and glides,grade I and II with the joint placed in a pain free position.
  • Once the inflammation subsides,stretch grades III and IV using techniques that focus on the restricting capsular tissue at the end of the available range of motion are applied to increase joint capsule mobility.
  • Self-mobilization techniques are then taught for home program.

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