|
|
Adhesive capsulitis??
|
Logged in as: Guest
|
|
Users viewing this topic:
none
|
|
Login  | |
|
Adhesive capsulitis?? - August 23, 2006 3:06:00 AM
|
|
|
cclem2000
Posts: 21
Joined: August 7, 2006
Status: offline
|
I have been seeing several people lately with diagnosis of shoulder adhesive capsulitis and they are most limited with IR with little to no limitation of ER. Of course their complaint is that they cannot reach up behind their back and have pain with doing so
Looking for any thoughts, suggestions, exercises, ideas,etc
_____________________________
Chesson Clement PT, OCS
|
|
|
|
|
Re: Adhesive capsulitis?? - August 23, 2006 5:09:00 PM
|
|
|
ginger
Posts: 660
Joined: February 26, 2005
From: Melbourne Victoria
Status: offline
|
thoroughly mobilise the cervical spine till protective tone and pain with mobs is close to zero and the so called advesive capsulitis will be revealed to have been a referred event from inflamed joint/nerve (spondyl) there. Shoulder symptoms will begin to be reduced within the first ten minutes of continuous mobs to C5, further improvements will almost certainly take place with similar attention to the balance of the cervical spine on the side of pain.
Poor diagnostic technique by doctors of medicine have historicaly lumped the frozen shoulder/adhesive capsulitis ( and a bunch of other names for 'I dont know') into the pathological bag.
You will find that attention to the cervical spine will offer immediate and long term amelioration of both painfull shoulder movements and the ongoing state of poor muscle recruitment associated with this condition.
Think spine first, shoulder second.
_____________________________
Ubi est mea anaticula cumminosa?
The Grand Pediculator
|
|
|
|
|
Re: Adhesive capsulitis?? - August 24, 2006 3:04:00 AM
|
|
|
cclem2000
Posts: 21
Joined: August 7, 2006
Status: offline
|
what do you mean by continuous mobs to C5
_____________________________
Chesson Clement PT, OCS
|
|
|
|
|
Re: Adhesive capsulitis?? - August 24, 2006 12:03:00 PM
|
|
|
yarringtonpt
Posts: 112
Joined: July 4, 2006
From: Waynesville, NC
Status: offline
|
Chesson:
Look under the Manual Therapy thread on this site for continuous mobs.
_____________________________
Eric Yarrington, PT, MPT, OCS
|
|
|
|
|
Re: Adhesive capsulitis?? - August 24, 2006 12:19:00 PM
|
|
|
nari
Posts: 1568
Joined: November 14, 2003
From: Australia
Status: offline
|
I agree with ginger. The cervicothoracic junction is often an interesting spot to investigate with all shoulder pain.
I'd leave the shoulder alone until the spine is cleared down to T4 or so.
Exercises to a shoulder can aggravate this sort of pain. Sure, it might improve with exercise and time. But it is better to exclude the likely source of nociception.
Nari
|
|
|
|
|
Re: Adhesive capsulitis?? - August 24, 2006 8:47:00 PM
|
|
|
james097
Posts: 178
Joined: January 27, 2005
From: West Vancouver BC
Status: offline
|
Chesson, You say you have seen several patients recently with the diagnosis of adhesive capsulitis. So who made the diagnosis, your post seems to imply not you. Firstly adhesive capsulitis is quite rare and only occurs in 45 to 60 year olds. If a patient has no restriction of ER, I presume that means external rotation then they can't have a capsular pattern. If internal rotation is truly limited by even just a few degrees lateral rotation will be noticably restricted. Also if internal rotation is performed only by the patient and not passivly by the therapist we don't know how much movement is truly limited, perhaps not at all. Also unlike lateral rotation which never has a painful arc, internal rotation can, so passively rotating the humerus has to be performed even if it is painful.
If any movement is truly restricted then the limted range routine examination should be performed. If the range is full then the full range examination has to be performed.
Jim McGregor
|
|
|
|
|
Re: Adhesive capsulitis?? - August 27, 2006 8:43:00 AM
|
|
|
emad/emad
Posts: 42
Joined: July 4, 2006
Status: offline
|
Jim;
I do NOT think frozen shoulder is rare ,personally i see many patients with shoulder pain and stiffness of the joint ,what ever calling it !
When we look at the shoulder as secondary to cervical region in most cases seems not fair , as so we skiped over orthopedic cases we encounter daily/traumatic ,which the nervous System get involoved in following injuries whose cervical pluxes are communicator to shoulder and whole upper quarter .
Cheers
Emad
|
|
|
|
|
Re: Adhesive capsulitis?? - August 27, 2006 2:40:00 PM
|
|
|
james097
Posts: 178
Joined: January 27, 2005
From: West Vancouver BC
Status: offline
|
Emad,
You lost me, frozen shoulders are rare, patients with stiffness and pain in the shoulder are common. Stiffness and pain about the shoulder is not necessarily a frozen shoulder and a history and examination is needed to make this diagnosis.
The patient lost medial rotation and if passive movement can get a full range the we would be correct in looking for another anatomical entity using selective tissue tension. Every effort must be made to find the offending tissue or neurological cause of the grief. Only then can you have a plan of treatment which may well be to the spine or directly to the joint or it's soft tissues. At least when you examine well you can easily see and measure the improvement that you have caused.
Jim McGregor
|
|
|
|
|
Re: Adhesive capsulitis?? - August 28, 2006 5:57:00 AM
|
|
|
emad/emad
Posts: 42
Joined: July 4, 2006
Status: offline
|
Jim;
What are the measures/markers of reaching Frozen shoulder level?
Persnally , i see no difference ,just different degress of nervous system sensitivity and pain severity .
cheers
Emad
|
|
|
|
|
Re: Adhesive capsulitis?? - August 28, 2006 8:22:00 AM
|
|
|
james097
Posts: 178
Joined: January 27, 2005
From: West Vancouver BC
Status: offline
|
Emad, Before I answer explain, "I see no difference". No difference from what?
Jim
|
|
|
|
|
Re: Adhesive capsulitis?? - August 28, 2006 9:51:00 AM
|
|
|
emad/emad
Posts: 42
Joined: July 4, 2006
Status: offline
|
Jim,
I meant that i do not see great/significant difference between Frozen shoulder and other shoulder injuries complicated by stiffness and pain except in ;
Pain Severity
Nervous System Sensitivity degree
Cheers
Emad
|
|
|
|
|
Re: Adhesive capsulitis?? - August 29, 2006 7:44:00 PM
|
|
|
james097
Posts: 178
Joined: January 27, 2005
From: West Vancouver BC
Status: offline
|
Emad,The frozen shoulder is different to any other joint. No frozen hips, knees or wrists. As I have said it usually comes on between 45 and 60. It follows a fixed course mostly with the same ratios of freezing, staying frozen and thawing. It comes without trauma or any known cause. Early on ranges are full with an ache usually around the insertion of deltoid. On passive movements soreness is complained at the ends of the ranges. Resisted movements are pain free. After about a couple of months the ache becomes intense going from the shoulder to the wrist. Night pain is the worst and it becomes increasingly difficult to rest on that side. Limitation of a capsular pattern appears at about 3 months. At this stage any unintential or jarring movements cause sharp and severe pain.
The stiffnes never increases after 4 months. At five or so months pain begins to abate and by 6 months pain is much less. The pain leaves the wrist and generally moves to the upper arm. Ranges are regained over the next few months and with a year normality should have returned.
No muscle bulk or weakness is noted.
If ever the joint loses almost all of it's range and muscle wasting is apparent some rheumatoid condition may be the cause.
Jim McGregor
|
|
|
|
|
Re: Adhesive capsulitis?? - August 29, 2006 9:23:00 PM
|
|
|
ginger
Posts: 660
Joined: February 26, 2005
From: Melbourne Victoria
Status: offline
|
Have to agree with emad on his view that there is no difference between "frozen shoulder " and non traumatised sore shoulder. Agree, in the sense that, when effective restoration of normal pain free movements is provided to the cervical spinal joints associated with this joint, the pain of both "types' resolves quickly. I am of the opinion that the only difference , as emad has said , is how long and how severe , has been the neurogenic effect.
_____________________________
Ubi est mea anaticula cumminosa?
The Grand Pediculator
|
|
|
|
|
Re: Adhesive capsulitis?? - August 29, 2006 10:08:00 PM
|
|
|
nari
Posts: 1568
Joined: November 14, 2003
From: Australia
Status: offline
|
I totally agree with emad and ginger. Limited ER and abd in the early stages can be reversed, particularly with attention to the cervicothoracic jctn and neurodynamics to down regulate. Trouble is, we usually don't see patients in the early stages.
It is self-limiting, then the advanced changes (post three months)we see are almost impossible to reverse, though it can happen, as ginger indicates, and that is preferable to local forced techniques by the sound of it.
Nari
|
|
|
|
|
Re: Adhesive capsulitis?? - August 29, 2006 10:26:00 PM
|
|
|
ginger
Posts: 660
Joined: February 26, 2005
From: Melbourne Victoria
Status: offline
|
Always good when a patient can be seen to avoid the ongoing "natural history" as it is termed ( what a cruel thing this is ), and have the cervico/thoracic joint problem resolved before the so called frozen issue dominates. Pain however from this distressing complaint, is all too often misconstrued as of local origin, while even more distressing glenohumeral stretches and mobilisations are attempted. Makes me shudder knowing this still goes on.
_____________________________
Ubi est mea anaticula cumminosa?
The Grand Pediculator
|
|
|
|
|
Re: Adhesive capsulitis?? - August 30, 2006 4:39:00 AM
|
|
|
garyd
Posts: 15
Joined: October 6, 2004
Status: offline
|
Quote from nari
"...particularly with attention to the cervicothoracic jctn and neurodynamics to down regulate."
Could you please elaborate on the "treatment" indicated and performed at the cervicothoracic junction. Is this mobilization, manipulation, thrust????
Please provide some specifics on what is meant by the term neurodynamics, and the treatment techniques associated with that term.
I am here to learn and appreciate the response.
Gary
|
|
|
|
|
Re: Adhesive capsulitis?? - August 30, 2006 4:51:00 AM
|
|
|
Shill
Posts: 1096
Joined: February 13, 2003
From: Madison WI USA
Status: offline
|
So Ginger, do you still shudder when you read the research regarding loss of the inferior capsular redundancy? What say you of this, and other arthroscopic and histologic abnormalities found in capsules of shoulders with contractures? I do seriously want your opinion of this, since you allude to the condition not actually existing.
Thanks,
Steve
_____________________________
Steve Hill PT
|
|
|
|
|
Re: Adhesive capsulitis?? - August 30, 2006 5:32:00 AM
|
|
|
Sebastian Asselbergs
Posts: 1203
Joined: September 29, 1999
From: Barrie, Canada
Status: offline
|
I'm occasionally gripped by a need to be the devil's advocate (nothing personal, Ginger !):
Arthroscopic and histological abnormalities are found, but how have they been correlated in a linear fashion to the complaint of the patient? Have they been shown to be the CAUSE of the "frozen shoulder"? Or is it just a tissue condition often seen in the cases with frozen shoulder....Which is quite significant...
_____________________________
Mundi vult decipi
|
|
|
|
|
Re: Adhesive capsulitis?? - August 30, 2006 7:16:00 AM
|
|
|
Shill
Posts: 1096
Joined: February 13, 2003
From: Madison WI USA
Status: offline
|
Oh great, call him the devil. Now he will change to the Grand Pediculator from Hell. Nice job Sebastian. Kidding my friend. We can still joke on this site, right?
Not sure on the cause of the frozen shoulder, but pretty sure that it is the reason for the lack of movement. Regardless, I do not feel that the capsule will miraculously change and become pliable through means that are not directed at the tissue responsible for the lack of motion. Yes, I do admit that there is a lot of stuff in there, and the effects are spread out amongst all the stuff. Perhaps enough to not know which tissue we are truly affecting. Still, I think that it should be possible to objectively find these other reasons for pain, something like an abundance of nerves stuck in the capsule, and pulled on with attempts to move, or some variation there of, and I have yet to see anything convincing me of this.
_____________________________
Steve Hill PT
|
|
|
|
|
Re: Adhesive capsulitis?? - August 30, 2006 7:24:00 AM
|
|
|
emad/emad
Posts: 42
Joined: July 4, 2006
Status: offline
|
Steve :
Could you provide give us a link to that research or at least past a copy of the abstract here !!
Gary,As you have no idea regarding Neural Mobilizations or clinical Neurodynamics of the Nervous System , I suggest searching for any of the Vocublaries Using GOOGLE /YAHOO and you can add to names of those shared to develop the Technique as Micheal Shacklock or David Butler.
Jim,you mentioned that Frozen shoulder exists only for shoulders(GH joints) ,yes,most of texts mentioned as you said ,however currently i have a young boy of 17 years with hip joint severe pain and no motion why not i can nOT call that boy hip as frozen Hip , i am trying to address him after 8 months .Anyway,seems the shoulder anti-gravity direction of motion and its anatomy let to what we call frozen .
Cheers
Emad
|
|
|
|
 New Messages |
 No New Messages |
 Hot Topic w/ New Messages |
 Hot Topic w/o New Messages |
 Locked w/ New Messages |
 Locked w/o New Messages |
|
 Post New Thread
Reply to Message
Post New Poll
Submit Vote
Delete My Own Post
Delete My Own Thread
Rate Posts |
|
0.078
|
Printable Version
