UNDERSTANDING FROZEN SHOULDER

FROZEN SHOULDER , PERIARTHIRITIS OF SHOULDER AND ADHESIVE CAPSULITIS ARE SYNONIUM  IN MEDICAL VOCABALARY . SHOULDER  JOINT MOVEMENT ARE RESTRICTED  ACTIVELY AS WELL AS PASSIVELLY AND PAINFUL. MORE PRECISELY ABDUCTION, EXTERNAL ROTATION AND INTERNAL ROTATION OF SHOULDER JOINT ARE MOST AFFECTED MOVEMENTS.

 PATIENT FEEL PAIN IN SUDDEN JERKY MOVEMENT – CAN’T SLEEP ON THAT SIDE . SLEEP DISTRUBE DUE TO PAIN.

 -DIFFICULTY IN WEARING OF CLOTHES ESPECIALLY UNDERGARMENTS.

 -SOMETIMES CONSTANT PAIN.

ANALYSIS

 GLENO HUMERAL JOINT IS STIFF OR HYPO MOBILE (GH) .

THORACO-SCAPULAR JOINT IS HYPERMOBILE

G.H JOINT-ROTATOR CUFF MUSCLES ARE TIGHT OR SHORT

 CAPSULE IS TIGHT

TEST

PATIENT POSITION –PRONE LYING SHOULDER  90ABDUCTION. ELBOW 90 FLEXED .

MOVE THE ARM UPWARD ( EXTERNAL ROTATION) –SCAPULA GOES IN ABDUCTION.IT MEANS POSTERIOR CAPSULE IS TIGHT.

MOVE THE ARM  DOWNWARD ( INTERNAL ROTATED)- SCAPULA GOES IN ADDUCTED POSITION.

BOTH TEST ARE SUGGESTIVE OF GH JOINT  LIGHTNESS IN COMPANSION TO THORACO- SCAPULAR JOINT.

IN SUCH SITUATION IF WE TRY TO INCREASE ROM OF ABDUCTION OR INTERNAL ROTATION OR EXTERNAL ROTATION ALL FORCE IS TRANSMITTED TO HYPER MOBILE-SCAPULA-THORACO JOINT RATHER THAN GH JOINT.

                           FORCE PASSIVE MOVEMENTS OR STRETCHING OF  SHOULDER JOINT COMPLEX,INEFFECTIVE TO GH JOINT .WE HAVE TO DISGUSE A STRETCHING PROGRAMME IN SUCH A WAY THAT WORK ON GH JOINT-

EXERCISE FOR FORZEN SHOULDER

ACCERARY JOINT MOVEMENTS ARE VERY IMPORTANT FOR COMPLITION OF PHYSIOLOGICAL MOVEMENTS.

SUPERIOR TRANSLATION OF HUMERAL HEAD

ANTERIOR TRANSLATION OF HUMERAL HEAD

INFERIOR AND POSTERIOR TRANSLATION OF HEAD

THESE ARE ACCECERRY MOVEMENTS  OF SHOLDER JOINT.

WHILE YOU TRYING TO INCREASE INTERNAL ROTATION EXCESSIVE ANTERIOR TRANSLATION TAKE PLACE. WITH EXCESSIVE TRANSLATION JOINT CAPSULE TRAUMATISE AND FURTHER DETERIATE THE SYMPTOMS

1.AVOID SUPERIOR TRANSLATION

2.AVOID ANTERIOR TRANLATION 

THESE ACCESSORY MOVEMENT TAKE PLACE WHEN YOUR DO PHYSIOLOGICAL MOVEMENT-

WHICH YOU TRY TO INCREASE INTERNAL ROTATION ANTERIOR GLIDE START AT GH JOINT

ON ELEVATION SUPERIOR GLIDE IS CLEARLY VISIBLE.

DO POSTERIOR GLIDES AND INFERIOR GLIDES

NO EXERCISE IF PAIN IN REST (IT IS SUGGESTIVE OF ACTIVE INFLAMMATION)

DO POSSIVE EXERCISE WITH POSTERIOR AND INFERIOR GLIDE

RESTORE MEDIAL ROTATION FIRST

NO ABDUCTION UNTIL 75%MEDICAL ROTATION RESTORE

DESIGN EXERCISE IN SUCH A WAY SO THAT SCAPULAR MOVEMENT  ARE STIFER.

UNDERSTANDING FROZEN SHOULDER

FROZEN SHOULDER , PERIARTHEOLIS OF SHOULDER AND ADHESIVE CAPSULITIS ARE SYNONIUM JANGON IN MEDICAL VOCABALARY . SHOULDER  JOINT MOVEMENT ARE RESTRICTED  ACTIVELY AS WELL AS PASSIVELLY AND PAINFUL ALSO MORE PRECISELY ABDUCTION, EXTERNAL ROTATION AND INTERNAL ROTATION OF SHOULDER JOINT ARE MOST AFFECTED MOVEMENTS.

 PATIENT FEEL PAIN IN SUDDEN JERKY MOVEMENT – CAN’T SLEEP ON THAT SIDE . SLEEP DISTRUBE DUE TO PAIN.

 -DIFFICULTY IN WEARING OF CLOTHES ESP. UNDERGARMENTS.

 -SOMETIMES CONSTANT PAIN.

ANALYSIS- GLENO HUMERAL JOINT IS STIFF OR HYPO MOBILE (GH)JOINT .THORACO-SCAPULAR JOINT IS HYPERMOBILE

G.H JOINT-ROTATOR CUFF MUSCLES ARE LIGHT OR SHORT CAPSULE IS LIGHT

TEST – PATIENT POSITION –PRONE LYING SHOULDER  90 DEGREE ABDUCTION. ELBOW 90 FLUXED .

GH JOINT- EXTERNAL ROTATION –SCAPULA GOES IN ADDUCTED.(POST CAPSULE  TIGHT)

GH JOINT INTERNAL ROTATED- SCAPULA GOES IN ADDUCTED POSITION.

BOTH TEST ARE SUGGESTIVE OF GH JOINT LIGHTNESS IN COMPANSION TO THORACO- SCAPULAR JOINT.

IN SUCH SITUATION IF WE TRY TO INCREASE ROM OF ABDUCTION OR INTERNAL ROTATION OR EXTERNAL ROTATION ALL FORCE IS TRANSMITTED TO HYPER MOBILE-SCAPULO-THORACIC JOINT RATHER THAN GH JOINT.

                           FORCE PASSIVE MOVEMENTS OR STRETCHING OF  SHOULDER JOINT COMPLEX,INEFFECTIVE TO GH JOINT .WE HAVE TO DISGUSE A STRETCHING PROGRAMME IN SUCH A WAY THAT WORK ON GH JOINT-

EXERCISE FOR FORZEN SHOULDER

1.AVOID SUPENSIVE GLIDE

2.AVOID ANTENSIVE GLIDE 

THESE  ACCESSORY MOVEMENT TAKE PLACE WHEN YOU DO PHYSIOLOGICAL MOVEMENT-WHICH YOU TRY TO INCREASE INTERNAL ROTATION ANTERIOR GLIDE START AT GH JOINT

ON ELEVATION SUPERIOR GLIDE IS CLEARLY VISIBLE . THEREFORE AVOID THESE MOVEMENT BUT WITHOUT GLIDES.

UNDERSTANDING FROZEN SHOULDER

DO POSITION GLIDES

INFERIOR GLIDE

NO EXERCISE IF PAIN IN REST (IT IS SUGGESTIVE OF ACTIVE INFLAMMATION)

DO POSSIVE EXERCISE WITH POSITION AND INFERIOR  GLIDE

RESTORE MEDICAL ROTATION FIRST

NO ABDUCTION UNTIL 75%MEDICAL ROTATION RESTORE

DESIGN EXERCISE IN SUCH A WAY SO THAT SCAPULAR MOVEMENT  ARE STIFFER.

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