shoulder joint Assessment Adhesive capsulitis ppt

1. SHOULDER ASSESSMENT
SUBJECT: PT IN ORTHO

2. FUNCTIONAL
ANATOMY
SUBJECTIVE
EXAMINATION
OBSERVATION PALPATION
EXAMINATION
SPECIAL TESTS
OUTCOME
MEASURES
OVERVIEW

3. FUNCTIONAL ANATOMY OF
SHOULDER JOINT
• ITS JOINT OF UPPER LIMB
• TYPE-SYNOVIAL JOINT
• BALL AND SOCKET VARIETY
• JOINTS- GLENOHUMERAL JOINT
• ACROMIOCLAVICULAR JOINT
• STERNOCLAVICULAR JOINT
• VERY MOBILE BUT ALSO VERY UNSTABLE

4. FUNCTIONAL ANATOMY

6. Dynamic Stablisers

7. SUBJECTIVE ASSESSMENT
Date:
• Name:
• Age:
• Gender:
• Occupation:
• Address:
• Date of Assessment:
• Chief Complaint:

8. PATIENT HISTORY

9. PRESENT HISTORY
• Onset of symptoms: Sudden/ Gradual
• Mechanism of injury
• Mode of onset
• Location
• Condition - Improved, stationary,
Deteriorated
• Muscular Weakness

10. PAIN HISTORY
• Duration of symptoms
• Type of pain
• Aggravating and Relieving factors

11. PAST HISTORY
• Any history of Tuberculosis
• Bronchial Asthma
• Blood Pressure
• Diabetes
• Cardiac Problems
• Enquiry made for any accidental injury

12. FAMILY HISTORY
• Hereditary?
PERSONAL HISTORY
• Cigarettes –
• Alcoholic –

13. SOCIOECONOMIC HISTORY
MEDICAL HISTORY
Present medication patient is on

14. ON OBSERVATION
GENERAL
• Facial Expression:
• Posture
• Anterior view
• Posterior view
• Lateral view

15. ANTERIOR VIEW

16. STEP DEFORMITY

17. SULCUS SIGN

18. POSTERIOR VIEW

19. SPRENGEL'S DEFORMITY

20. SCAPULAR DYSKINESIA

21. LATERAL VIEW

22. DELTOID ATROPHY

23. LOCAL
• Attitude of limb / Deformity
• Muscle Wasting
• Redness
• Scar
• Trophic Changes

24. ON PALPATION
• SC joint
• Clavicle
• Coracoid process
• LT and GT of Humerus
• AC joint
• Spine of scapula
• Medial Border of scapula
• Spine of scap
• Temperature
• Tenderness
• Spasm:-
• Swelling
• Crepitus / Abnormal sounds

25. ON EXAMINATION
• Range of Movement : Active and Passive
Range of Movement

26. • Sensations:
Superficial
Deep

27. Manual Muscle Testing

28. SPECIAL TESTS
• Sulcus sign
• Hawkins- Kennedy Test
• Apley’s Scratch Test
• Drop Arm Test
• Yergason’s Test
• Empty Can Test
• Apprehension Test

29. PROVISIONAL DIAGNOSIS:
INVESTIGATIONS:
DIFFERENTIAL DIAGNOSIS:
CLINICAL (FINAL) DIAGNOSIS:
MANAGEMENT: Goals / Treatment / Home
advices

30. SHOULDER JOINT CAPSULE
• A loose fibrous structure that surrounds the GH joint
and is attached;
• Scapula: margin of glenoid fossa
• Root of coracoid process
• Humerus: Margin of anatomical neck
• Weak
• Large
• Loose

31. ADHESIVE CAPSULITIS

32. EPIDEMIOLOGY
• Affects 2% to 5% of the total world
• population
• Its more common between the age of 40-65
• More in women than in Men1.4:1.
• Bilateral involvement occurs in 10 to 40% of cases
• Does not usually recur in the same shoulder
• 70% of the cases are women

33. ETIOLOGY
SHOULDER
RELATED
• Trauma
• Tendonitis
• Rotator cuff injury
• Overuse & faulty
mov.
• Poor sleeping
posture
NON SHOULDER
RELATED
•Diabetes
•Thyroid
•Prolonged
immobilization
•Muscle Weakness

34. CLINICAL FEATURES
• Pain
• Inflammation
• Stiffness
• Progressive loss of active and passive move.

35. FREEZING PHASE
(1-3month)
• Night pain
• Stiffness
• Progressive restriction of movement mainly
external rotation and Abduction.
• Pain may radiates down the arm
• Patient adapts the adduction & internal
rotation of shoulder joint

36. FROZEN PHASE
(3-6 months)

37. THAWING PHASE
(6-18months)
• Pain Deminished
• Restriction of movement
• Muscle Weakness
• Reverse scapulohumeral rhythm

38. DIFFERENTIAL DIAGNOSIS
1. Impingement syndrome
2. Rotator cuff Tendonitis
3. Anterior Instability

39. INVESTIGATION
1. Plain X- ray
2. MRI

42. MEDICAL MANAGEMENT
•NSAIDs
• Ibuprofen
•Paracetamol
• Celecoxib
• Diclofenac
•CORTISONE INJECTIONS
• Hydrocortisone

43. PHYSIOTHERAPY
MANAGEMENT
AIM
1. Relief of pain
2. Maintenance of ROM
3. Maintenance of Muscle Strength
4. Restoration of ROM
5. Restoration of Muscle Strength
6. Correction of Posture

44. Physiotherapy management of AC
Classified into three Stages:
1. FIRST STAGE ( STAGE OF PAIN)- (1-3
Months)
2. SECOND STAGE ( STAGE OF
STIFFNESS) - (3-6 month)
3. THIRD STAGE ( Stage of Recovery) -
(6-18 month)

45. FREEZING STAGE
(1-3month)

46. FROZEN STAGE
(3-6month)
ELECTROTHERAPY
1. SWD
2. IR
3. UST
GENERAL MOBILISATION
Passive gliding with longitudinal traction
•Anterior
•Inferior. Grade 1,2&3
•Posterior

47. FROZEN STAGE
Foreward stopped postion

48. THAWING STAGE
(12-18 months)
• Mobilisation Grade 3&4
• Passive ROM Exercises
• Active Assisted ROM Exercises
• Active ROM Exercises
• Strengthening of shoulder muscles
• Capsule stretching

49. 1. Shoulder elevation with flexion, abduction
and external rotation
2. Shoulder internal rotation with extension
3. Shoulder wheel
4. Shoulder Pulley
5. Shoulder ladder

50. REFERENCES

51. https://i0.wp.com/ptmasterguide.com/wp-
content/uploads/2018/12/images-
672.jpeg?fit=554%2C553&ssl=1
https://images.app.goo.gl/f9yUnZ1mCRMhLzF
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