FROZEN SHOULDER, PERIARTHERITIS OF SHOULDER AND ADHESIVE CAPSULITIS ARE SYNONIUM JARGONS IN MEDICAL VOCABALARY. SHOULDER JOINT ACTIVE AND PASSIVE MOVEMENTS ARE RESTRICTED PAINFULLY. MORE PRECISELY ABDUCTION, EXTERNAL ROTATION AND INTERNAL ROTATION OF SHOULDER JOINT ARE MOST AFFECTED MOVEMENTS. THERE IS GLOBAL MOVEMENTS RESTRICTION.
UNDERSTAND BIOMECHANICS OF SHOULDER JOINT
FLEXION OR ABDUCTION OF SHOULDER JOINT ACCOMLISHED WITH HUMERAL HEAD START TRANSLATE DOWNWARD
ARM START MOVING IN EXTERNAL ROTATION.
SIMULTANEOUSLY SCAPULA ALSO MOVE WITH HUMERAL HEAD IN 1:2 RATIO.
IT MEANS IF GH JOINT MOVE 90 DEGREE UP SCAPULA MOVE 30 DEGREE. UNDERSTANDING THIS MECHANISM IS IMPORTANT TO CHECK THE DYNAMIC CENTER OF ROTATION (D.C.R.)
SYMPTONS OF FROZEN SHOULDER
- PATIENT FEEL PAIN IN SUDDEN JERKY MOVEMENT
- CAN’T SLEEP ON THAT SIDE.
- SLEEP DISTRUB DUE TO PAIN.
- DIFFICULTY IN WEARING OF CLOTHES ESP. UNDERGARMENTS.
- SOMETIMES CONSTANT PAIN.
ANALYSIS- GLENO HUMERAL JOINT IS STIFF OR HYPO MOBILE
G.H JOINT- ROTATOR CUFF MUSCLES ARE TIGHT OR SHORT
- CAPSULE IS TIGHT OR FIBROSED.CAPSULE ELSTICITY REDUCED
- CAPSULE MAY ADHERE TO ADJACENT TISSUE
- GLOBAL RESTRICTION OF MOVEMENTS ARE DUE TO FIBROSIS OR ADHESIONS
TEST -
HOW TO CHECK IF GH JOINT STIFF OR NOT
PATIENT POSITION –PRONE LYING SHOULDER 90◦ DEGREE ABDUCTION. ELBOW 90◦ FLEXED .
ACTION- EXTERNALLY ROTATED BY RAISING ARM UP
SCAPULA GOES IN ABDUCTION.
INTERNALLY ROTATED- SCAPULA GOES IN ADDUCTED POSITION.
IT MEANS POST CAPSULE IS TIGHT IN COMPARISION TO THORACO-SCAPULAR JOINT
BOTH TEST ARE SUGGESTIVE OF GH JOINT TIGHTNESS IN COMPARISON TO THORACO- SCAPULAR JOINT.
IN SUCH SITUATION IF WE TRY TO INCREASE RANGE OF MOTION OF GLENO-HUMERAL JOINT ALL FORCE IS TRANSMITED TO HYPER MOBILE-SCAPULO-THORACIC JOINT RATHER THAN GH JOINT. SHOULDER JOINT COMPLEX ROM INCREASE BUT G.H. JOINT MOVEMENT REMAIN SAME. IT FURTHER DETERIATE JOINT BIOMECHANICS.
FORCE PASSIVE MOVEMENTS OR STRETCHING OF SHOULDER JOINT COMPLEX,INEFFECTIVE TO GH JOINT .WE HAVE TO DESIGN A STRETCHING PROGRAM IN SUCH A WAY THATFORCE WORK ON GH JOINT ONLY.MILD FORCE FOR LONG DURATION IS GOOD OPTION.
A FEW SUGGESTINS REGARDING EXERCISE FOR FROZEN SHOULDER
1. AVOID SUPERIOR GLIDE
2. AVOID ANTERIOR GLIDE
- THESE ACCESSORY MOVEMENT TAKE PLACE WHEN YOU DO PHYSIOLOGICAL MOVEMENT.TIGHTNESS OF JOINT CHANGE ACCESORY MOVEMENT PATTERN.
- INTERNAL ROTATION IS ASSOCIATED WITH ANTERIOR TRANSLATION OF HUMERAL HEAD AT GH JOINT
- ON ELEVATION SUPERIOR GLIDE IS CLEARLY VISIBLE . THEREFORE DO THESE MOVEMENT BUT WITHOUT TRANSLATION OF HEAD OF HUMERUS .
- DO POSTERIOR GLIDES
- DO INFERIOR GLIDE
- NO EXERCISE IF PAIN IN REST (IT IS SUGGESTIVE OF ACTIVE INFLAMMATION)
- DO PASSIVE EXERCISE WITH POSTERIOR AND INFERIOR TRANSLATED POSITION
- RESTORE MEDIAL ROTATION FIRST
- NO ABDUCTION UNTIL 75%MEDICAL ROTATION RESTORE
- DESIGN EXERCISE IN SUCH A WAY SO THAT SCAPULAR MOVEMENT ARE STIFFER.
