6/6/2011. Unraveling the Mystery of Shoulder Pain #4: Adhesive Capsulitis (Frozen Shoulder)
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1 Unraveling the Mystery of Shoulder Pain #4: Adhesive Capsulitis (Frozen Shoulder) Instructor: Ben Benjamin, Ph.D. 1
2 Instructor: Ben Benjamin, Ph.D. Webinar Goal Explore the assessment and treatment of one of the most painful shoulder injuries: Adhesive Capsulitis 2
3 Time: 1 hour Schedule: Logistics Presentation min Questions min Ongoing questions: Use Question box. If I don t get to your question, ask me on my Dr Ben Benjamin Facebook page after the webinar. Get a pen and paper please Pretest 1. Frozen shoulder is most common in: a. men in their 50s b. women in their 30s c. men and women in their 40s d. women in their 40s 2. The inability to lift the arm overhead is the most important test when assessing adhesive capsulitis. True or False? 3. Resisted tests are of little importance when a frozen shoulder is present. True or False? 4. Traumatic arthritis sets up a pattern of limited movement that is the same for every person who has it. True or False? 5. Which is the most important assessment test when testing for a frozen shoulder? a. passive adduction b. passive lateral rotation c. resisted scapulohumeral abduction d. passive elevation 3
4 Anatomy Shoulder Joints Acromioclavicular Sternoclavicular Glenohumeral 4
5 Glenohumeral Joint Glenohumeral Joint Ligaments Coracohumeral ligament Glenohumeral ligaments Transverse humeral ligament Limits the degrees of movement at the glenohumeral joint 5
6 Coracohumeral Ligament Glenohumeral Ligaments SGHL: superior glenohumeral ligament MGHL: middle glenohumeral ligament IGHL: inferior glenohumeral ligament 6
7 Transverse Humeral Ligament Glenohumeral Joint Structure Shallow joint that permits a huge range of motion More range of motion means greater vulnerability to injury 7
8 Joint Capsule Secretes synovial fluid to allow joint bones to glide over one another Joint Injury Capsular contracture: Most limited by anterior adhesions Second most limited by inferior adhesions Least limited by posterior adhesions 8
9 Assessment Capsular Pattern A characteristic pattern of limitation of a specific joint when it is inflamed 9
10 Assessment Tests Passive Lateral Rotation Passive Medial Rotation Passive Scapulohumeral Abduction Passive Lateral Rotation 10
11 Passive Medial Rotation Passive Scapulohumeral Abduction 11
12 Theory Three Names for this Condition: Traumatic Arthritis Adhesive Capsulitis Frozen Shoulder 12
13 What Happens It hurts to lie on the injured side Pain radiates down the arm Pain is worse when arm is used Motion is very limited Who Is Affected Most often women between 40 and 50 years old Also occurs in men 13
14 Stages of Frozen Shoulder Freezing: Condition worsens for 3-4 months Frozen: Pain is constant and steady for 3-4 months Thawing: Pain improves gradually over 3-4 months Variations in Recovery Spontaneous recovery one year Condition persists indefinitely Pain decreases or disappears but limitation of movement remains 14
15 Clinical Application A Personal Experience 15
16 Assessment Test Results for Frozen Shoulder Passive Lateral Rotation most limited movement, very painful Passive Scapulohumeral Abduction less limited movement and pain Passive Medial Rotation least limited movement and pain Treatment 16
17 Treatment 1st Trimester: Stretching & resisted stretching 2nd Trimester: Stretching & resisted stretching 3rd Trimester: AIS stretching & strengthening Resisted Stretching 17
18 Resisted Stretching Resisted Stretching 18
19 Active Isolated Stretching Watch the video at the end of the Webinar Questions Facebook.com/DrBenBenjamin 19
20 Post-test 1. Frozen shoulder is most common in: a. men in their 50s b. women in their 30s c. men and women in their 40s d. women in their 40s 2. The inability to lift the arm overhead is the most important test when assessing adhesive capsulitis. True or False? 3. Resisted tests are of little importance when a frozen shoulder is present. True or False? 4. Traumatic arthritis sets up a pattern of limited movement that is the same for every person who has it. True or False? 5. Which is the most important assessment test when testing for a frozen shoulder? a. passive adduction b. passive lateral rotation c. resisted scapulohumeral abduction d. passive elevation 20
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