Capsular pattern pada idiopathic

frozen shoulder

Oleh Sugijanto
 IDIOPHATIC FROZEN SHOULDER

Functioning, and disability Constextual factors

Anatomic impairment
Internal factors External factors
Nerves
GH Capsels Muscle

AC Capsels Autonom
Nocisensoric
system
Chronic Scapulo thoracal
inflamation muscle weakness
Inter fiber Sympathic
Cuff ms Vascular
adhesion hyperactivity
tightness
Contracture, anterior Micro circular Functional Activity Participation
- inferior capsel most constriction impairment limitation restriction
contracted
Stretched Muscle
Capsular pain Activity with
imbalance Work
pattern mobility/ADL
Pain
Driving Sport

Recreation
Hypomobility
Sugijanto, 2015
PEMERIKSAAN FISIOTERAPI YG
DIBUTUHKAN
Diutamakan pemilihan evidence untuk:
 Pemeriksaan terhadap frozen shoulder:
◦ Abduction-elevation: Reverse
Humeroscapular rhythm
◦ Passive external rotation: the most limited
 Pemeriksaan Capsels:
◦ Passive test other: External rotation <
Abduction < internal rotation with elastic
end feel.
◦ Joint Play Movement Test: Taction at end
range position  elastic end feel

Sugijanto, 2015
 Capsular pattern Hypomobility
Frozen Shoulder
Abd-elevation  Reverse
Humeroscapular Rhythm

Scratch test: Pain, limited

Nyeri &
gerak Pasif: Ext rot < Abd < int
terbatas rot: elastic-firm e.f.

JPM test: Pain, elastic-firm

end feel

Sugijanto, 2015
TES EVIDENCE BASE FROZEN
SHOULDER
 Scapulohumeral rhythm: Abduksi
elevasi
 Scratch Test: Hand Behind Head and
Hand Behind Back
 Capsular contracture: rotasi
eksternal

Sugijanto, 2015
TES PASIF

 Abduksi
 Rotasi eksternal
 Rotasi internal
◦ Capsular pattern (rot. eksternal
< abduksi < rot. internal): elastic-
firm end feel

Sugijanto, 2015
TES KHUSUS

 Joint play movement test

◦ Inferior capsel, anterior capsel,
posterior capsel dan superior capsel.
◦ Nyeri, range terbatas, elastic endfeel

Sugijanto, 2015
 Pemeriksaan panjang otot: Contract
relax stretch test:
◦ Terbatas atau lemah
 Pemeriksaan Otot stabilisator:
◦ Isometric test
◦ Sabilizing test
 Pemeriksaan Scapular mobility:
◦ Abduction-elevation
◦ Tolak pinggang
 Pemeriksaan
◦ ULTT (upper limb tension test)

Sugijanto, 2015
FISIOTERAPI YG DIBUTUHKAN
 MODALITAS DAN METODA
◦ Anatomic Impairment target:
 US / SWD contra planar tepat utk capsel
yg tegang
 Scapular mobilization
 Shoulder joint mobilization, traction at
end range position and Roll glide
 Stabilizing exercise tepat utk kelemahan
otot bahu.
◦ Functional Impairment target:
 Latihan mobilisasi sendi
 Latihan stabilisasi bahu
◦ Disability target

Sugijanto, 2015
INTERVENSI
 Scapulo-thoracal mobilization
 Glenohumeral mobilization:
◦ Oscillated traction in MLPP
◦ Roll glide abduction
◦ Roll glide horizontal abd.
◦ Roll glide horizontal add.
 ACJ mobilization

Sugijanto, 2015
ALAT UKUR/EVALUASI
FISIOTERAPI YG DIBUTUHKAN

 Pengukuran nyeri
 Pengukuran ROM,
 Pengukuran fleksibilitas/ekstensibilitas
otot
 Pengukuran disabilitas

Sugijanto, 2015