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)

Rotation components Int & Ext rotation twisting with glides

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

- 1962

Stage

II
Acute synovitis with proliferative synovitis

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

IV
Chronic stage with fully mature adhesions with notable restriction of ROM

Description Pre adhesive stage with little or no restrictions

Classical complaints
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

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

Mobilization therapy

What is the advanced management ?

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

 Grade I -Small amplitude rhythmic oscillations are performed at the beginning of the range Grade II -Large amplitude rhythmic oscillations are performed at within the range not reaching the limit Grade III -Large amplitude rhythmic oscillations are performed up to the available ROM and are stressed into the tissue resistance

 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?

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

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

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