Periarthritis shoulder ppt (1)

PRESENT BY

DEBANJAN MONDAL

MPT(ORTHO)

A COMPARATIVE STUDY BETWEEN

EFFICACY OF END RANGE MOBILIZATION

AND MOBILIZATION WITH MOVEMENT TO

IMPROVE THE ABDUCTION RANGE IN

PERIARTHRITIS SHOULDER.

INTRODUCTION

The common condition in the shoulder joint is Periarthritisof the glenohumeral joint which affects the function of theshoulder causing pain and limitation of range of motion.

Mobilization is a form of passive exercise designed torestore joint play motions of roll, glide and jointseparation. They are passive skilled manual therapytechniques applied to joints at varying speeds andamplitudes using physiological or accessory motions. Thequantity of movement can be measured by using anUniversal Goniometer, quality of movement is tested bythe therapist observing the active movement.

End range mobilization of extremity joints consists of two passive

rectilinear movements traction/separation and translatoric gliding,

called joint play, and depends on concave convex rule.

There are 3 grades of Mobilization-

Grade I(Loosen) Small amplitude distraction is applied where no

stress is placed on the capsule. It equalizes the cohesive forces, muscle

tension, and atmospheric pressure acting on the joint and is used with

all gliding movement and may be used for relief of pain.

Grade II(Tighten) Enough distraction or glide is applied to tighten

the tissues around the joint “taking up the slack” and is used for initial

treatment to determine how sensitive the joint is. Once joint reaction is

known, the dosage of treatment is either increased or decreased

accordingly.

Grade III (stretch) A distraction or glide is applied with an amplitude

large enough to place a stretch on the joint capsule and on surrounding

periarticular tissues.

Brian Mulligan’s concept of Mobilization With Movement

is the progression in the development of manual therapy from

active stretching exercise to therapist applied passive

physiological movement to passive accessory mobilization

techniques. MWM is the application of a sustained accessory

mobilization applied by the therapist and an active

physiological movement to end range applied by the patient.

Both the End range mobilization and Mobilization with

movement concepts place particular emphasis on restoration

of glide component of joint movement to facilitate full pain

free range of movement.1

AIMS AND OBJECTIVES

1. To study the efficacy of End range mobilizationon improving the abduction Range of Motionand function in subjects with Periarthritisshoulder.

2. To study the efficacy of mobilization withmovement on improving the abduction ROMand function in subjects with Periarthritisshoulder.

3. To compare the efficacy of End rangemobilization and Mobilization With Movement onimproving the abduction ROM and Function insubjects with Periarthritis shoulder.

HYPOTHESIS

Experimental Hypothesis

Mobilization With Movement will be more effective than Endrange mobilization technique in improving abduction range andfunction in subjects with Periarthritis shoulder.

Alternative Hypothesis

End range Mobilization will be more effective than MobilizationWith Movement technique in improving abduction range andfunction in subjects with Periarthritis shoulder.

Null Hypothesis

Mobilization With Movement will be as effective as End rangemobilization technique.

METHODOLOGY

SAMPLING METHOD

The study included a sample of 40 subjects

who were diagnosed as having Periarthritis

of the glenohumeral joint and having a typical

restriction of external rotation, abduction and

internal rotation the most. The subjects

between the age group of 40 and 70 years

were randomly selected.

METHOD OF COLLECTION OF DATA

These subjects were then divided randomly into 2groups, Group A and Group B.

Group A of 20 subjects were given End rangemobilization technique.

Group B of 20 subjects were given MobilizationWith Movement.

The treatment for both the groups were given for 10to 15 repetitions in 6 sitting. Although subjects willbe treated for improving all the restricted movementsof shoulder joint, recording and study wereconducted on abduction range.

SOURCE OF DATA COLLECTION

Data will be taken from physiotherapy

department of Doon paramedical college,

Dehradun.

VARIABLES

Independent variable

Universal goniometer (3600).

Mulligan belt.

Dependent variable

Range of motion.

Shoulder pain and disability index.

INCLUSION CRITERIA

Subjects with restriction of external rotation,

abduction and internal rotation of the

glenohumeral joint when compared to the

opposite side.

Subjects with the history of painful, restricted

shoulder for at least 3 months and not more

than 9 months.

EXCLUSION CRITERIA

Subjects with Uncontrolled diabetes.

Unstable joint

Post traumatic shoulder stiffness

Hemiplegic Shoulder joint

Concurrent cervical signs and symptoms

History of fracture and dislocation of the shoulder

Post surgical cases around shoulder

Bicipital tendonitis

Supraspinatus tendonitis

Painful arc syndrome

Thoracic outlet syndrome

Cases of diagnosed bone infections

PROTOCOL

Subjects meeting the inclusion criteria

Subjects included in the study (n=60)

Subjects randomly assigned into two group

Number of subjects

randomly assigned for

hip muscle

strengthening (n=30)

Number of subjects

randomly assigned for

hip muscle

strengthening (n=30)

Received allocated

treatment (n=30)

Received allocated

treatment (n=30)

Data collected Data collected

Interpreted Interpreted

PROCEDURE

They were then randomly divided into Group A and Group B of 20 subjects each. The base line data of ROM of all the movements of shoulder is obtained using universal goniometer, but the recording and study were done only on abduction range pre and post treatment on alternate days for 6 sitting. The pain and disability data were obtained using SPADI to check for the functional outcome on the 1st sitting before the treatment and on the 6th sitting after the treatment.

ROM MEASUREMENT

ROM is measured by using Universal Goniometer(3600)

1. The patient is in sitting position.

2. Center of the fulcrum of the goniometer close to theposterior aspect of the acromial process.

3. Align the proximal arm parallel to the spinous processof the Vertebral column.

4. At the end of ROM align the distal arm with the lateral

midline of the humerus using the lateral epicondylereference.

SPADI SCORE MEASUREMENT

Pain and disability is evaluated by using SPADI. It consist of 2 self report sub scales of pain and disability. The two sub scale are VAS and ADL. The VAS consist of 5 question in order to evaluate patient’s pain during ADL and each question is anchored by the descriptions “no pain” (left anchor) and “worst pain imaginable” (right anchor). The second scale (ADL) consist of 8 disability question asked to the patient about their difficulty in performing ADL. These questions are anchored with the descriptions “no difficulty” (left anchor) and “so difficult it required help”(right anchor).

Each item is scored by measuring the distance from

the left anchor to the mark made by the person. First,

questions scored within the sub scale are summed.

Second, this sum is divided by the summed distance

possible across all questions of the subscales to which

the patient responded. Third, this ratio is multiplied by

100 to obtain a percentage. Higher scores on the sub

scale indicate greater pain and greater disability. To

obtain the total score of SPADI both the pain and

disability subscales are averaged.

Group A of 20 subjects received End range

mobilization for 6 sitting on alternate days. Prior to the

treatment the subjects were evaluated for the

abduction range. Moist heat is applied prior to the

treatment for 10 minutes. End range mobilization is

then performed for all the restricted movements of the

glenohumeral joint but the recording is done on

abduction ROM.

There are 3 grades of Mobilization-

Grade I (Loosen) Small amplitude distraction is applied

where no stress is placed on the capsule.

Grade II (Tighten) Enough distraction or glide is applied to

tighten the tissues around the joint “taking up the slack” and is

used for initial treatment to determine how sensitive the joint.

Grade III (Stretch) A distraction or glide is applied with an

amplitude large enough to place a stretch on the joint capsule.

The traction mobilization using grade 3 is held for 5 to 10

seconds using as much force as the patient can comfortably

tolerate and it is not necessary to release the joint completely

between traction mobilization, a return to the place between

grade 1 and grade 2 is adequate before repeating the process.

END RANGE MOBILIZATION TECHNIQUE

Starting position: Patient lies supine on the table withthe arm abducted approximately to 550. The therapiststands facing the lateral side of the upper arm.

Fixation: Will be done using a towel for scapularfixation.

Procedure: Therapists right hand hold around patientselbow and forearm from the ventral side. Left hand holdsaround the humeral head with the thumb ventrally justdistal to the acromium and the direction of movement istowards caudal assisted by therapists body.

Group B of 20 subjects were received Mobilization

With Movement for 6 sitting on alternate days 10 to 15

repetition. Prior to the treatment subjects were

evaluated for abduction range. Moist heat is applied

for 10 minutes. Mobilization With Movement

technique is then performed for all the restricted

movements of the glenohumeral joint but the

recording is done for abduction ROM.

MOBILIZATION WITH MOVEMENT TECHNIQUE

Starting position: The subjects made to sit, the therapist stands behind the patient and places the belt around his both hips and the patients shoulder.

Fixation: The therapist places his hand on the scapula for fixation.

Procedure: The patient is asked to raise his arm up from his side while the glide is applied posteriorly by the therapist over the head of the humerus by leaning back in such a way as to glide the humeral head in the treatment plane. Before and after the treatment in both groups, abduction ROM is measured using universal goniometer on alternate days for ten sittings and functional outcome is measured using SPADI on the first sitting day before and the tenth sitting day after the treatment.

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