6/6/2011 1 Unraveling the Mystery of Shoulder Pain #4: Adhesive Capsulitis (Frozen Shoulder) Unraveling the Mystery of Shoulder Pain #4: Adhesive Capsulitis (Frozen Shoulder) Instructor: Ben Benjamin, Ph.D. Instructor: Ben Benjamin, Ph.D. Instructor: Ben Benjamin, Ph.D. Instructor: Ben Benjamin, Ph.D. [email protected] [email protected]
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6/6/2011
1
Unraveling the Mystery of Shoulder Pain #4:
Adhesive Capsulitis(Frozen Shoulder)
Unraveling the Mystery of Shoulder Pain #4:
Adhesive Capsulitis(Frozen Shoulder)
Instructor: Ben Benjamin, Ph.D.Instructor: Ben Benjamin, Ph.D.
Instructor: Ben Benjamin, Ph.D.Instructor: Ben Benjamin, Ph.D.
[email protected]@benbenjamin.com
6/6/2011
2
Webinar GoalWebinar Goal
Explore the assessment and treatment of one of the most painful shoulder injuries: Adhesive Capsulitis
LogisticsLogistics• Time: 1 hour
• Schedule:
• Presentation 30–40 min
• Questions 15–20 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
• Time: 1 hour
• Schedule:
• Presentation 30–40 min
• Questions 15–20 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
PretestPretest1. Frozen shoulder is most common in:
a. men in their 50sb. women in their 30sc. men and women in their 40sd. 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 adductionb. passive lateral rotationc. resisted scapulohumeral abductiond. passive elevation
1. Frozen shoulder is most common in:a. men in their 50sb. women in their 30sc. men and women in their 40sd. 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 adductionb. passive lateral rotationc. resisted scapulohumeral abductiond. passive elevation
6/6/2011
3
AnatomyAnatomy
Shoulder JointsShoulder Joints
• Acromioclavicular
• Sternoclavicular
• Glenohumeral
• Acromioclavicular
• Sternoclavicular
• Glenohumeral
Glenohumeral JointGlenohumeral Joint
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Glenohumeral Joint LigamentsGlenohumeral Joint Ligaments
• Coracohumeral ligament
• Glenohumeral ligaments
• Transverse humeral ligament
• Coracohumeral ligament
• Glenohumeral ligaments
• Transverse humeral ligament
Limits the degrees of movement at the glenohumeral joint
Coracohumeral LigamentCoracohumeral Ligament
Glenohumeral LigamentsGlenohumeral Ligaments
SGHL: superior glenohumeral ligament
MGHL: middle glenohumeral ligament
IGHL: inferior glenohumeral ligament
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Transverse Humeral LigamentTransverse Humeral Ligament
Glenohumeral Joint StructureGlenohumeral Joint Structure
• Shallow joint that permits a huge range of motion
• More range of motion means greater vulnerability to injury
• Shallow joint that permits a huge range of motion
• More range of motion means greater vulnerability to injury
Joint CapsuleJoint Capsule
• Secretes synovial fluid to allow joint bones to glide over one another
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Joint InjuryJoint Injury
Capsular contracture:
• Most limited by anterior adhesions
• Second most limited by inferior adhesions
• Least limited by posterior adhesions
Capsular contracture:
• Most limited by anterior adhesions
• Second most limited by inferior adhesions
• Least limited by posterior adhesions
AssessmentAssessment
Capsular PatternCapsular Pattern
• A characteristic pattern of limitation of a specific joint when it is inflamed
• A characteristic pattern of limitation of a specific joint when it is inflamed
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Assessment TestsAssessment Tests
• Passive Lateral Rotation
• Passive Medial Rotation
• Passive Scapulohumeral Abduction
• Passive Lateral Rotation
• Passive Medial Rotation
• Passive Scapulohumeral Abduction
Passive Lateral RotationPassive Lateral Rotation
Passive Medial RotationPassive Medial Rotation
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Passive Scapulohumeral AbductionPassive Scapulohumeral Abduction
TheoryTheory
• Traumatic Arthritis
• Adhesive Capsulitis
• Frozen Shoulder
• Traumatic Arthritis
• Adhesive Capsulitis
• Frozen Shoulder
Three Names for this Condition:Three Names for this Condition:
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• It hurts to lie on the injured side
• Pain radiates down the arm
• Pain is worse when arm is used
• Motion is very limited
• It hurts to lie on the injured side
• Pain radiates down the arm
• Pain is worse when arm is used
• Motion is very limited
What HappensWhat Happens
• Most often women between 40 and 50 years old
• Also occurs in men
• Most often women between 40 and 50 years old
• Also occurs in men
Who Is AffectedWho Is Affected
• 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
• 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
Stages of Frozen ShoulderStages of Frozen Shoulder
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• Spontaneous recovery one year
• Condition persists indefinitely
• Pain decreases or disappears but limitation of movement remains
• Spontaneous recovery one year
• Condition persists indefinitely
• Pain decreases or disappears but limitation of movement remains
Variations in RecoveryVariations in Recovery
Clinical ApplicationClinical Application
A Personal ExperienceA Personal Experience
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• Passive Lateral Rotation –most limited movement, very painful
• Passive Scapulohumeral Abduction – less limited movement and pain
• Passive Medial Rotation –least limited movement and pain
• Passive Lateral Rotation –most limited movement, very painful
• Passive Scapulohumeral Abduction – less limited movement and pain
• Passive Medial Rotation –least limited movement and pain
Assessment Test Resultsfor Frozen Shoulder
Assessment Test Resultsfor Frozen Shoulder
TreatmentTreatment
1st Trimester: Stretching & resisted stretching
2nd Trimester: Stretching & resisted stretching
3rd Trimester: AIS stretching & strengthening
TreatmentTreatment
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Resisted StretchingResisted Stretching
Resisted StretchingResisted Stretching
Resisted StretchingResisted Stretching
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Active Isolated StretchingActive Isolated Stretching
Watch the video at the end of the WebinarWatch the video at the end of the Webinar
QuestionsQuestions
Facebook.com/DrBenBenjaminFacebook.com/DrBenBenjamin
Post-testPost-test1. Frozen shoulder is most common in:
a. men in their 50sb. women in their 30sc. men and women in their 40sd. 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 adductionb. passive lateral rotationc. resisted scapulohumeral abductiond. passive elevation
1. Frozen shoulder is most common in:a. men in their 50sb. women in their 30sc. men and women in their 40sd. 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 adductionb. passive lateral rotationc. resisted scapulohumeral abductiond. passive elevation
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