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Frozen Shoulder Exercises aim to reduce pain, increase extensibility of the capsule, and improve strength of the rotator cuff muscles.
The basic aim of exercises are:
Though prior heating of the joint has been found to facilitate relaxation and mobilization, one may use the heat modality suitable to the patient's response. However ultrasound, beside deep heating, has the added advantages of increasing excitability of the contracted soft tissue and is therefore performed.
The patient is placed in supine position with the affected shoulder in maximum possible abduction and neutral rotation and elbow in 90 degree of flexion. The physiotherapist grasping the arm above the shoulder joint carries out relaxed passive gliding movement of head of humerus on glenoid. Axial traction and approximation is carried out along with antero-posterior glide and abduction- adduction glide. To induce relaxation, always begin with slow rhythmic movement.
Slow and rhythmic circumduction at the glenohumeral joint, in forward stoop position effectively induces relaxation and promotes mobility. Gentle relaxed passive movements reduces pain and pathologic limits of motion. The reduction in pain occurs because of the neuro-modulation effect on the mechanoreceptors with in the joint.
Mobilization by accessory movements of acromio-clavicular, sterno-clavicular and/or scapulo-thoracic joint articulation is also extremely helpful.
Frozen shoulder exercises plays an important role in management of the condition. While planning the frozen shoulder exercises one must give due importance to the fact that contracted soft tissue when objected to repeated prolong mild tension show extensibility and plastic elongation.
An increase in the movement following the session of prolonged stretching was usually associated with a corresponding increase in the other movements too. However improvement in the range of other movements is not always at the same rate.
The specific Frozen shoulder exercises should include the maximum number of combination of various movement by minimising the number of exercises. Graduated relaxed sustained stretching based on the PNF pattern are following types:
The above mentioned Frozen shoulder exercises can be done in two ways:
For this, manipulation and mobilising techniques are given by"MAITLAND". By this patient respond very well for acquiring full range by properly guided simple and specific Frozen shoulder exercises which ensures relaxed graduated stretching of the contracted capsule.
Codman introduced the term "frozen shoulder" in 1934 to describe patients who had a painful loss of shoulder motion with normal radiographic studies. In 1946, Neviasernamed the condition "adhesive capsulitis" based on the radiographic appearance with arthrography, which suggested "adhesion" of the capsule of th GH joint limiting overall joint space volume. Patients with adhesive capsulitis have a painful restriction of both active and passive GH joint motion in all planes, or a global loss of GH joint motion.
The condition is common in people of 40-60 years age group, with a higher incidence in females. The onset of an idiopathic frozen shoulder has been associated with extended immobilization, relatively mild trauma, and surgical trauma, especially breast and chest wall procedures. Adhesive capsulitis is associated with medical conditions such as diabetes, hyperthyroidism, ischemic heart disease, inflammatory arthritis and cervical spondylosis. Most significant association is with Insulin dependent diabetes.
Length of each stage is variable, but typically the first stage lasts for 3-6 months, the second stage from 3-18 months, and the final stage from 3-6 months.
Not every stiff or painful shoulder is a frozen shoulder, and indeed there is some controversy over the criteria for diagnosing "frozen shoulder". Stiffness occurs in a variety of conditions- arthritic, rheumatic, post-traumatic, and post operative. The diagnosis of frozen shoulder is clinical resting on two characteristic features.
When the patient is seen first, a number of conditions should be excluded: infection, post traumatic stiffness, diffuse stiffness and reflex sympathetic dystrophy.
In general, a global loss of active and passive motion is present; the loss of external rotation with the arm at the patient's side is a hallmark of this condition. The loss of passive external rotation is the single most important finding on physical examination that helps to differentiate the diagnosis from a rotator cuff problem because problems of the rotator cuff generally do not result in a loss of passive external rotation.
Even though adhesive capsulitis is believed to be a "self limiting" process, it can be severely disabling for months to years and, as a result, requires aggressive treatment once the diagnosis is made. Initial treatment should include an aggressive frozen shoulder exercises to help regain shoulder motion. For patients in the initial painful or freezing phase, pain relief may be obtained with a course of anti-inflammatory medications, the judicious use of GH joint corticosteroid injections, or therapeutic modality treatments. Intra-articular corticosteroid injections help to abort the abnormal inflammatory process often associated with this condition.
Operative intervention is indicated in patients who show no improvement after a three month course of aggressive management that includes medications, corticosteroid injection and physical therapy.
No restriction or immobilization.
Motion: Frozen Shoulder Exercises
Criteria for progression to Phase 2
Motion: Frozen Shoulder Exercises
Perform active, active assisted and passive range of motion exercises to obtain around 140 degree of forward flexion, 45 degree of external rotation and internal rotation to twelfth thoracic spinous process.
Criteria for progression to Phase 3
Please check with your Physical Therapist before starting with this frozen shoulder exercises.
Treatment of Complications:
Return from Frozen Shoulder Exercises to Sports Physical Therapy
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