Busy. Please wait.

Don't have an account? Sign up

taken

Age:

12 or younger
13 or older

Make sure to remember your password. If you forget it there is no way for StudyStack to send you a reset link. You would need to create a new account. Your email address is only used to allow you to reset your password. See our Privacy Policy and Terms of Service.

Already a StudyStack user? Log In

Reset Password

Enter the email address associated with your account, and we'll email you a link to reset your password.

Upgrade to remove ads

Tx of Stiff Shoulder

Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.

Normal Size Small Size show me how

Created by: 1190550002

Popular Physical Therapy sets

The Gait Cycle

Capsular Patterns

Origins, Insertions, Actions and Inervations of Shoulder Muscles

(CN) The Joints - Anatomy, ROM, Ortho

(CN) The Shoulder

NPTE Neuromuscular

Primitive Infant Reflexes

NPTE: Integumentary (scorebuilder 2008)

NPTE: Special Tests and (+) result indications (scorebuilder 2008)

NPTE: Cardiac (scorebuilders 2008)

Gait - ROM requirements for normal gait (PTA - Irongirl)

(CN) Nerve Root, Muscle Weakness, Reflexes

Question	Answer
Main difference between true adhesive capsulitis & stiff/painful shoulder	True adhesive capsulitis will have a capsular pattern; stiff/painful shoulder may not
Causes of Adhesive Capsulitis	Contractures of intra-articular capsule or mm-tendon units Scar tissue bt tissues that normally move against one another easily Adhesions within extra-articular humeroscapular or scapulothoracic motion interface
Stiff & Painful Shoulder	Painful Limited motion No true capsular pattern of restriction Motion lmited by pain/stiffness only
History & Physical Exam in Stiff Shoulder	Onset more acute & severe Repetitive OH activity or trauma No mechanical restriction, just pain at end range With frozen shoulder there should be a mechanical stop to capsular contracture
Pathology of Frozen Shoulder	Inflammatory rxn in capsule & synovium that subsequently leads to formation of adhesions, specifically in the axillary fold & attachment of capsule at anatomic neck of humerus
Primary (Idiopathic) Frozen Shoulder	No known precipitating event Immunologic, inflammatory, biochemical, endocrine alternations 2-3% US population; women>men; 50-70 y.o.; NOT preferential to handedness; could occur bilaterally More common in sedentary people
Secondary Frozen Shoulder	Associated with or attributed to other illness/events
Intrinsic Secondary Frozen Shoulder causes	AC joint arthritis RTC tendonitis/tear
Extrinsic Secondary Frozen Shoulder causes	Cardiac disease/surgery Neuro disorders with impaired consciousness/hemiplegia Pulmonary disease Shoulder trauma/humeral fx Cervical radiculitis Personality disorders
Which 2 disease states are frozen shoulders more common in?	Thyroid Disease Diabetes
Pre-Adhesive/Freezing Phase	Little/no limitation of motion Fibrinous synovial inflammatory rxn detectable by arthroscopy
Painful/Freezing Phase	10-36 wks long Severe pn Disturbs sleep Diminution of articular/capsular volume Proliferative synovitis & early adhesion formation (adhesions well into dependent axillary fold & extend to humeral head)
Stiffening/Frozen Phase	4-12 months long Pain usually decreases gradually but w/o appreciable improvement in ROM
Thawing Phase	12 months-years long (avg. 5-26 months) Gradual return of motion May be directly related to duration of painful stage
What is the total course of frozen shoulder?	1-4 years Most pts have residual s/sx years after onset S/sx rarely interfere with work/ADLs Mild loss of ER/abd ROM
Key Features of Diagnosis	Sub-acute onset of unilateral shoulder pn Little-no trauma/overuse Limited AROM/PROM Endpoint leathery, occurs earlier than normal Pain with rest & activity Can't sleep Pain over biceps groove (overcompensation) Pain into C5 derm at insertion of de
What is the reason patients usually seek medical help?	Limited ROM
Acute Findings	Protective of involved limb Motion guarded Arm held in add/IR Protected mm spasm ROM difficult to assess b/c of pain/guarding Substitution patterns Empty end feel due to pain
Sub-Acute/Chronic Findings	*Motion Restriction Substituting scapular for GH mvmt May need scapular stab Overuse of upper traps Atrophy- RTC, delts, tris, bis Tender biceps groove Ssn/reflexes normal MMT- weak/asymptomatic at end range Tight ant/inf capsule- loss of ER/abd
Humeroscapular Motion Interface	All GH motion accompanied by gliding of biceps in bicipital groove ST jt responsible for ~1/3 shoulder ROM Loss of scapular motion = overall decreased ROM
Treatment	Frozen shoulder is self-limiting No standard tx regimen universally accepted PT, Rest, analgesia, ROM ex's; Prednisone; Corticosteroid injections
Capsular Distention	Injection of fluid into shoulder joint to stretch out capsule Shoulder may tighten up again afterward
Manipulation under anesthesia	Works well ~12 wks before feeling much better, very painful procedure Risk of iatrogenic fx, GH dislocation, RTC tear, nerve injuries Surgical capsular release
Plastic Deformation	Microtrauma at cellular level breaking the cross-links of the peri-articular connective tissue & elongating actual collagen bundles
Phase I Rehab	Decrease pn & inflammation Exercise in pain-free ROM AAROM & PROM ex's Don't allo shoulder shrug (impingement) HEP done 10-12x/day (more is better) Heat application
Circle Concept	Round capsule surrounding shoudler; if you injure something on one side, you'll probably injure something on the other side
Phase 2- Transitional Phase	Decrease pn & inflammation More aggressive ROM/mobs HEP 10x/day Continue heat followed by slightly more aggressive mobs Avoid vigorous forceful ex's to limit exacerbation
Phase 3- Light Phase	ROM HEP 4-6x/day LLLD stretching- 60 mins total of TERT to stretch out mm/capsule
Phase 4- Maintenance Phase	Stretch 3-5x/day AAROM Self capsular stretches RTC program Monitor ROM progression
Keys to Recovery	Compliance is critical Avoid immobilization Avoid over-aggressive ex's Gradual & steady progression rather than rushed & hurried