RE: Information Exchange: Adhesive Capsulitis (Full Version)

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gerry -> RE: Information Exchange: Adhesive Capsulitis (February 13, 2008 3:35:51 PM)

I would say that with adhesive capsulitis, there is greatly decreased movement and dissociation, but there is still some movement between the humerus and scapula.  With the decreased joint space and tight capsule, it would not take much to get bumping of parts together, creating impingement in places there might not normallly be a problem. 

I found the old thread on my shoulder, and it was helpful to me in remembering what happened.  I was involved in PT throughout and got several different opinions from colleagues.  I was actively working on exercises for what I still think was an impingement problem prior to beginning to lose so much of the range of motion.  The pain became my primary focus, and when I finally got relief, I went for months without working to increase the range because I did not want to flare it up again.  I got very good at substituting and would not admit how limited my shoulder was until my wife "made" me go for PT to get the range back.  It was not until then that the agressive stretching really seemed helpful.



james079 -> RE: Information Exchange: Adhesive Capsulitis (February 13, 2008 3:50:31 PM)

This has become too complicated for my old brain!  Erica has a patient who had a capsular pattern of the shoulder and who now has a non capsular pattern. The capsular pattern pattern should resolve in an orderly fashion, all  measurements improving in the same ratio. This would mean that a small amount of external rotation is the last to recover.  However with this patient the external rotation has not resolved as one would have expected. The shoulder is the commonest joint to be the bearer of more than one lesion, especially if any trauma, even minor, caused the original condition. Three entities will cause restricted external rotation, two cause true restriction and one which appears to.  Scarring of the anterior capsule is one reason. Secondly is tear or rupture of the infraspinatus tendon. The the patient is unable to rotate the humerus externally and eventually even passive movement is difficult.  The third is rare, subcoracoid bursitis.  As the patient can now elevate the humerus to the horizontal and if it is a bursitis it will be possible to externally rotate the humerus although pain will be present.
Jim McGregor



Shill -> RE: Information Exchange: Adhesive Capsulitis (February 14, 2008 9:27:47 AM)

Here is something that I have tried, as a means of stabilizing the hypermobile scapula when trying to gain back some ER.  There is a WOW factor to this, but not necessarily with results, just an amazement at how much the scapula substitutes, even in neutral ABDuction.

Patient sidelying, affected side up.  Humerus at neutral, elbow flexed to 90 degrees, hand allowed to fall inward towards belly.  Sneak one hand up and under the inferior angle of the scapula, palmar side of hand on ribs, fingers as far as you can get them under the lower 1/3 of the scapula, holding the inferior angle from moving.  Have the patient try to ER from this position.  The inferior angle of the scapula will move toward the ribs with more force than you can imagine.  I will try to prevent this from occurring, again in an effort to provide some dissociation in neutral, where capsular tightness should be less severe.



PTupdate.com -> RE: Information Exchange: Adhesive Capsulitis (February 14, 2008 11:17:17 AM)

Damn, I had two in last night for their follow ups, and would have liked to try that.  Thanks Shill, will do so next time I see them (probably have a few others tonight anyway) and post what I see



TexasOrtho -> RE: Information Exchange: Adhesive Capsulitis (February 19, 2008 11:58:06 PM)

I've been having a fun discussion of AC over on the SS forum.  Feel free to share thoughts.  I'm feeling a little outnumbered...[;)]



SJBird55 -> RE: Information Exchange: Adhesive Capsulitis (February 20, 2008 12:44:55 AM)

Rod, not all of us can... not all of us can.  You will probably be outnumbered because there are some of us that are forever banned from that site.  Good luck.



TexasOrtho -> RE: Information Exchange: Adhesive Capsulitis (February 20, 2008 12:51:04 PM)

I'd be interested in hearing about that.  Feel free to pm if you like or just let me know.  Seems like a sharp group over there but very eclectic.



avalon -> RE: Information Exchange: Adhesive Capsulitis (February 21, 2008 2:21:05 AM)

Well SJ that is another time, untrue.
You were banned for some reason it would be unreasonable to explain in this thread.
Many posters on SS (the complete name is banned here without any reason!) come from this site and are able to use their keyboard freely. Some are regular posters on the two "worlds".
Avalon : Administrator of the not allowed name forums...



SJBird55 -> RE: Information Exchange: Adhesive Capsulitis (February 21, 2008 7:36:13 AM)

You know what's really funny, but not.. no matter who tells the story, the story will be different.  Sometimes the stories are so different that you know that both can't be correct.  And then, you're left wondering who to trust.  Hmmmm.... Fact is, I AM forever banned.  Of course, the story revolving around why I am forever banned is what would probably be more entertaining for you, Rod.  All it would be is cheap entertainment.



avalon -> RE: Information Exchange: Adhesive Capsulitis (February 21, 2008 8:34:59 AM)

SJ,
You make a generalization, here. You are banned on SS for good reasons (for me).
You didn't brought a single scientific argument in your posts and the only thing you wanted was to bash Barrett. That's unfair and far from the scientific words we are asking on the site.
Secondly, as I said, there is many Rehabegers on SS that are free to take their keyboards and bring arguments. But that is true that your interventions were, ever... cheap (as you said).



TexasOrtho -> RE: Information Exchange: Adhesive Capsulitis (February 21, 2008 9:39:14 AM)

I certainly don't want to stir the pot.  Let's head to neutral corners.



SJBird55 -> RE: Information Exchange: Adhesive Capsulitis (February 21, 2008 7:24:15 PM)

Don't worry, Rod.  I'm the same here as I am over at MyPhysicalTherapySpace as I was at SS. You invited others to join you at SS.  I just let you know about things that happen at SS.  Rod, I can ignore Av... I was just responding so you wouldn't think I ignored your comment.  :)



ysumpt2006 -> RE: Information Exchange: Adhesive Capsulitis (February 21, 2008 11:08:06 PM)

I have used continuous ultrasound for thermal effects to help stretch the capsule. I have found this most effective when the ultrasound head is directed/applied to the axillary area. I had never used it before a few weeks ago. I had a young woman who was guarding like crazy in terms of ER PROM. I remembered a lecture from PT school where the professor stated this may help to heat the capsule in adhesive capsulitis.

She responded well after one application (for whatever reason). By the time she returned to the MD, she was at the range he wanted her to be at by that visit--prior to this technique, she was lagging behind greatly.

I don't know if the capsule was affected or if the heat helped calm the muscles, or the patient believed it would work, but it in this case, it helped.

ON another note, anyone have patients tear up (alligator tears) with stretching?



Kaden -> RE: Information Exchange: Adhesive Capsulitis (February 22, 2008 1:11:19 AM)

What the heck is the SS forum.



Kaden -> RE: Information Exchange: Adhesive Capsulitis (February 22, 2008 1:24:06 AM)

Okay, strike that, I figured it out.  



james079 -> RE: Information Exchange: Adhesive Capsulitis (February 22, 2008 1:53:17 AM)

ysumpt,
If your young woman patient was young she could not have had an adhesive capsulitis.
Jim McGregor



PTupdate.com -> RE: Information Exchange: Adhesive Capsulitis (February 22, 2008 9:16:45 AM)

I did not realize that typing the real name for SS gets audited.  Let me try:  SomaSimple

I have been following the same discussion on that site, at least until a couple of days ago.  Very interesting there as well, and I plan to print and read on paper, which for me always allows better digestion.  However, even with all the insight, theory, and challenge to critical thinking, I still did not learn anything that will coerce me to change what I am doing.  It will, however, be in the back of my head, and perhaps offer alternate explanations as to why something I do may work.



avalon -> RE: Information Exchange: Adhesive Capsulitis (February 22, 2008 10:58:52 AM)

quote:

I did not realize that typing the real name for SS gets audited. Let me try: SomaSimple


That is a good new. Thanks Dave.

Here is the link on our site:
http://www.somasimple.com/forums/showthread.php?t=5143



ysumpt2006 -> RE: Information Exchange: Adhesive Capsulitis (February 22, 2008 1:08:00 PM)

quote:

ORIGINAL: james079

ysumpt,
If your young woman patient was young she could not have had an adhesive capsulitis.
Jim McGregor


Well aware of the "typical patient". I was just stating that I used the US based upon what I remembered regarding it's use in Adhesive Capsulitis. She was still guarding and tight in a capsular pattern and for some reason the heat from the US helped. Who knows why.

Thanks for the "feedback", though.



avalon -> RE: Information Exchange: Adhesive Capsulitis (February 22, 2008 1:36:39 PM)

quote:

Who knows why.


hmmm... CNS?



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