Physiotherapy for the Stiff Shoulder
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Physiotherapy for Frozen Shoulder by Dr Tanya Mackeznie. Presented at The Wilmslow Hospital for The Arm Clinic's #stiffshoulder event, 29th April 2016
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Physiotherapy for the Stiff Shoulder
- 4. • OA • Locked posterior dislocation X-ray • Tumour • Infection • RA Red flags • M weakness (RC tears etc.) • Neurogenic MRI/US/N cdtn
- 5. HX of Uni - or multi - planar
- 6. PAINFULL PAIN = dominant feature = sever = at night FROZEN PAIN = slowly ↓ing = night p resolving =@ limit of ROM only Stiffness= dominant feature THAWING Pain = resolving ROM = ↑ing subjective (Walton & Russel, 2015)
- 7. ROM = grad loss esp ER AM vs. PM = but P limits ROM not stiffness PM End feel = spasm/empty/pain before resistance ROM = more global loss (only 40% had LAMB) (Rundquist 2003) AM vs. PM = AM=PM EROM & P simultaneous onset PM End feel = capsular/hard ROM = ↑ing AM vs. PM = AM=PM No EROM pain or P on OPress objective (Walton & Russel, 2015)
- 8. 1° Frozen Post -traumatic/-operative stiffness Antalgic sh (pain & muscle drivers) 1° Frozen Post -traumatic/-operative stiffness diagnosis (Walton & Russel, 2015)
- 12. Early phase keys PAIN SPASM IMMOBILISATION Break cycle PAIN: (moist heat/meds/etc…) SPASM: trigger pt or dry needle or STR esp subscap / gentle midrange sub max-isometrics ( CnR) IMMOBILISATION:AAROM/gentle PROM/Grade 1 & 2 PAMS of GHJ & EDUCATE, educate, educate, & keep educating NOT AGGRESSIVE
- 14. Mid phase keys EROM mobilisation & stretches can start Grade 3 & 4 GHJ PAMS & MWM Be specific – single plane better than multiple plane mobs (ER res thro abd ROM variable) Physiological stretching End range isometrics (PNF Contract relax) Isotonic exercises Pt home program NB +++++ EDUCATE regarding progression/regression risks - yoyo phase
- 15. Late phase As with mid phase Progress according to end feel LLLD = low load long duration stretches PAMS/MWM both single & MULTIPLE plane mobs Strengthen program
- 16. BUT: grps with ….better outcome but 441N-773N required to deform GHJ ST (Lee, 1999) GHJ PAMs = 39N. More likely restoring ghj kinematics not stretching non contractile structures
Editor's Notes
- Apart form only our clinical history taking & our clinical objective evaluation we have radiology etc to eliminate cause in those in the boxes. Challenge is these 3 at the bottom. Post trauma & operative is ass with op & trauma – obvious – uniplanar often – unless long period past then may be global stiffness ie multi planar stiffness.
- Apart form only our clinical history taking & our clinical objective evaluation we have radiology etc to eliminate cause in those in the boxes. Challenge is these 3 at the bottom. Post trauma & operative is ass with op & trauma – obvious – uniplanar often – unless long period past then may be global stiffness ie multi planar stiffness.
- GUESS THEPHASE PHASE ONE BREAK THE CYCLE ADDRESS PAIN AS PER PREVIOSU SLIDE SPASM dry needling STR esp subscapularis muscle etc. Try to get hem to move. – GHJ PAMS grade 1 & 2.
- GUESS THEPHASE PHASE ONE BREAK THE CYCLE ADDRESS PAIN AS PER PREVIOSU SLIDE SPASM dry needling STR esp subscapularis muscle etc. Try to get hem to move. – GHJ PAMS grade 1 & 2.
- GUESS THEPHASE PHASE ONE BREAK THE CYCLE ADDRESS PAIN AS PER PREVIOSU SLIDE SPASM dry needling STR esp subscapularis muscle etc. Try to get hem to move. – GHJ PAMS grade 1 & 2.