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RE: Information Exchange: Adhesive Capsulitis
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RE: Information Exchange: Adhesive Capsulitis - February 27, 2008 1:51:37 PM
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TexasOrtho
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quote:
ORIGINAL: avalon
quote:
Avalon. If you were to reflect upon your posts towards SJ, and ask yourself "Who am I helping with this post?", what would be your answer?
Simple: The PT community.
Wow...hilarious AND modest. Quite the jack of all trades.
_____________________________
Rod Henderson, PT
Board Certified Orthopedic Specialist (or Super-Freak)
Certified Strength and Conditioning Specialist
www.texasorthopedics.blogspot.com
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RE: Information Exchange: Adhesive Capsulitis - March 8, 2008 2:32:19 AM
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RSBMPT
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While saying the brain does not experience pain while unconscious is true, it is merely because pain is defined as conscious experience that has both sensory and emotional components to it. That being said the unconscious body does respond to noxious stimulus, producing reflexive behaviors as well as non-reflexive behaviors such as facial griamces, vocalizations and avoidance reactions. COuld it be possible to guard reflexibly while unconscious in response to a noxious stimulus? Who is to say that what the brain detects as noxious stimulus while unconscious, the individual may report as pain once conscious. Seems like 6 of one half and a half dozen of the other. All that being said, is it possible that as a consequence of bracing/splinting following initial trauma, that the nervous tissue may shorten (for lack of a better term, given that nerves trunks generally cross flexion aspects of joints as a protective mechanism) so that long lever stretching may be tractioning the nerve or at the very least significant upper limb nerve tension? Has anyone ever looked that upper limb nerve tension on the asymptomatic side to see if perhaps they may be predisposed to having a a significant neural component? I am not saying I look at this stuff all the time (I am usually on the side of aggressive stretching, at times belting the scapula down and stretching in all planes, and using every technique I have to improve the flexibility of any internal rotator if indicated) however found this thread interesting and wanted to put a couple of Loonies and Toonies into it.
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RE: Information Exchange: Adhesive Capsulitis - March 8, 2008 2:49:17 AM
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avalon
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quote:
is it possible that as a consequence of bracing/splinting following initial trauma, that the nervous tissue may shorten (for lack of a better term, given that nerves trunks generally cross flexion aspects of joints as a protective mechanism) so that long lever stretching may be tractioning the nerve or at the very least significant upper limb nerve tension?
Yes, and it has been demonstrated.
_____________________________
http://www.somasimple.com
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RE: Information Exchange: Adhesive Capsulitis - April 4, 2008 12:38:41 PM
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buckeye
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How about adhesive capsulitis and thyroid disease - anyone have information to share? How will they respond to PT? Any recommendations from the experts?
I have a patient with hypothyroid with a very stiff shoulder (90-100 flexion, 50-60 abduction, 20-30 external rotation, and 10-20 internal rotation). She is unable to put her forearm on her abdomen in a sling position due to the lack of motion. I did not see any neuro signs. No change in pain with cervical movements. Pain and stiffness with insidious onset - pain localized to shoulder. Have not seen imaging reports.
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RE: Information Exchange: Adhesive Capsulitis - April 21, 2008 9:35:33 AM
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JSPT
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Total tangent here:
I had a PT student tell me the other day that they learned how to "manipulate" an unpeeled banana, which resulted in the banana being neatly halved.
Anyone heard of this before?
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RE: Information Exchange: Adhesive Capsulitis - April 21, 2008 11:58:03 AM
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buckeye
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It is possible to halve, quarter, slice, etc. an unpeeled banana - it just takes a little preparation behind the scene. It is a neat stage presentation. I wonder what the professor had in mind when teaching this to students? Maybe about being careful with charlatans.
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RE: Information Exchange: Adhesive Capsulitis - May 11, 2008 1:44:27 AM
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supender
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I have always found using the pain resistance sequence a way to select my choice of treatment in adhesive capsultis. In clients where resistance follows pain I use
1)grade 1-2 oscillation, mobilisation,
2) trigger point release ( if present),
3) Proximal neural mobilisation (in patients with neuromechanosenstivity),
4) reassuring and silly talk, a few jokes,
5)some times ( having patient bring in their Ipod or CD man with headphones to relax during treatment),
6)often encouraging them to use the presribed pain medication to its full potential
7) if pain is interfering with sleep, advising patients to call their physician office requesting for pain medication and sleep aid.
8) If patient has AC joint tenderness,using dexamethasone iontophoresis with dexamethasone,AC joint mobilisation,using sidelying as a posture of choice for glenohumeral mobilisation (to avoid increased stress on AC joint.
This usually calm their neurological and local tissue with in in 3-5 visits or 1-2 weeks.Then these patient graduate to the point where either pain and resistance overlap or pain follows resistance.At this point I introduce end range grade 3-4 mobilisation, end range streching, prolonged strech with moist heat pack and thereband(if tolerated).Since publication of the article "The Effect of Anterior Versus Posterior Glide Joint Mobilization on External Rotation Range of Motion in Patients With Shoulder Adhesive Capsulitis" in JOSPT last year,I am more cognizant of the role of obligate translation in adhesive capsulitis.So I have been using both end range anterior and posterior glide for external and internal rotaion.I think doing that is improving gains in external as well as rotation.My two cents
Upender Singh PT,MPT,OCS
Board Certified Clinical Specialist
Orthopedic Physical Therapy.
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RE: Information Exchange: Adhesive Capsulitis - May 12, 2008 8:35:39 AM
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ginger
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Oh the tears and suffering, I cannot help but be a little moved when , in my own imagining, I see the pictures of therapists hauling away at people's painfull shoulders, in a bid to relieve their misery and restore pain free shoulder joint ROM and function . I cannot help also to be incensed and dissapointed , broadly speaking , at the degree to which most posters here , seem unwilling or unable to remove their focus from the painfull joint. It does seem that the pathology first methodology , seen in medical practitioners , has found a great many adherants in the world of PT. By this I refer to the mindset where MDs in general and medical specialists more so, seem unable to consider that pain and dysfunction may be of central origin ( referred ).
AS a late participant in this discussion , I must first state that it is my own practice to consider pain to be referred unless proven otherwise. Also , that in the process of restoring pain free range and function to sore tight shoulders, it is my first obligation to test this possibility. Indeed , in the process of discovering wether a painfull shoulder has or has not been affected by a central ( upper spinal ) neural mechanism, it is almost always my delight to find that so called adhesive capsulitis, ( a.k.a. glenohumeral syndrome, rotator cuff synd. , frozen shoulder etc )is a referred event.
By turning off protective responses at the upper spine, where this has given rise to hypomobility to facet joints ( principally but not limited to C456 )and subsequent nerve irritation , I am able to eliminate shoulder pain within one to three treatments. Corresponding immediate and permanent improvements are noted to shoulder ROM at the same time. In most cases little attention to shoulder structures is required, this depending on the time frame during which the condition had advanced.
Further manual therapy attention , as is mirrored by some posters here, to paravertebral musculature , along with shoulder girdle muscles , improves outcomes considerably. No stretching is required in the vast majority of cases. Where it is required , this is performed only AFTER pain has been eliminated by CM to C456 . My results are consistent with a wide range of presentations, ages, gender and apparent capsular inclusions. I hope this information may be of some help to those who have wondered if there may be a better way to resolve so called AC, without having to resort to painfull stretches of the shoulder.
_____________________________
Ubi est mea anaticula cumminosa?
The Grand Pediculator
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RE: Information Exchange: Adhesive Capsulitis - May 12, 2008 6:41:50 PM
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ginger
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From: Melbourne Victoria
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Sebastian, the more I read, in this and other blogs and forums , the insistant pathology first considerations of physios and PTs , with their minds ticking resolutely away at the detail of painfull structures, the more frustrated I seem to become. That is for me to deal with, though I share some of this with numerous posters worldwide.
Yes you are right, As a new grad , I began my attentions to shoulders with the tools and understandings I was taught. Only to find them woefully short on effectiveness. Those tools are similar to what are described by the Pts who stretch painfull shoulders. I can remember hospital departments where there was a wheel, with rungs able to be gripped ( or in some cases hands starpped to ! ) such that rotations of this enormous wheel moved painfull tight shoulders in a deliciously excruciating arc. The horror of it. I discovered one still being used in a country hospital I lectured at last year.
There will of course be many who will just never get it. Who will never experience the simply marvellous straighforward way that Continuous Mobs to spinal facet joints release and restore normal range and comfort to painfull structures where related nerve irritations have created persistant problems distally. Some will continue , for their own reasons ( weak hands, needing them held before embarking on a different course of action, those without the guide book, still more of beligerant intransigent disposition etc ) to keep doing what seems to confirm their outdated views. Even in the face of an appeal by many for a deep breath and heads up. I can only add my voice and hope for the best.
Go the Cats ( on top of the ladder and going strong for another premiership )
_____________________________
Ubi est mea anaticula cumminosa?
The Grand Pediculator
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RE: Information Exchange: Adhesive Capsulitis - May 12, 2008 7:00:07 PM
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SJBird55
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The biggest problem when it comes to treating shoulder complaints efficiently and effectively is that defined subgroups with intervening suggestions for interventions have not been fully established yet.
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RE: Information Exchange: Adhesive Capsulitis - May 12, 2008 9:10:12 PM
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TexasOrtho
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I know I bang this drum pretty regularly, but it most certainly does beg for a more consistent classification. Spratt's ADTO (Assessment-Diagnosis-Treatment-Outcome) model would help. Many of us have seen (will see) a predictable outcome following forceful mobilization via the traditional model. It seems I've become a bit more ginger (pun intended) with my approach and pay much more relative attention to central and neural components of the patients presentation.
However, there is overwhelming evidence to support a mechanical basis for these syndromes as well. I believe we are seeing a confluence of neurophysiologic and mechanistic phenomena that produce the complicated clinical problems. I think this explains why ginger's approach appears to be effective in her population while others may see success with a more traditional mechanistic approach. Getting back to Spratt's paradigm, this would fall under the assessment-diagnosis connection. Here many of us seem worlds apart in our assessment of what the problem is: stiff joint, neuroreflexive event, endocrine-mediated connective tissue disorder, oh yeah and skin  .
If we can't agree regarding the diagnosis and assessment of this syndrome from the cellular level on up, we will likely continue meeting at the tower of Babel to discuss our treatments and brag about the outcomes.
Romanes eunt domas
(I figured I'd join in on this post-modern craze of....latin phrases)
< Message edited by TexasOrtho -- May 12, 2008 9:15:19 PM >
_____________________________
Rod Henderson, PT
Board Certified Orthopedic Specialist (or Super-Freak)
Certified Strength and Conditioning Specialist
www.texasorthopedics.blogspot.com
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RE: Information Exchange: Adhesive Capsulitis - May 12, 2008 10:35:21 PM
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SJBird55
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psst... Rod, just a small hint. Ginger is a he.
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RE: Information Exchange: Adhesive Capsulitis - May 13, 2008 12:04:00 AM
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ginger
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From: Melbourne Victoria
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Using my outcomes and the observations of my students and patients , I wonder if the classification of non injury related shoulder problems could be as follows.
Subset a. Referred events from the upper spine , leading to shoulder pain, altered sensations of the upper limb along with some progressive limits to shoulder ROM, inhibition to normal patterns of muscular recruitment and the possibility of inflammatory 'disease' to shoulder synovial membranes.
Subset b. Other.( spontaneous tears, capsular inclusions, bony deformity, known hyperirritable disease conditions etc)
Subset a. would account for 90 percent ( or thereabouts ) of those who I treat.
The trouble is , those in subset b. would and ought to also be included in subset a..
That is , the likelihood of a referred event giving rise to distal pain etc is very high, certainly enough to appear in my own priority list as needing to be addressed a priori. It is really only after such matters have been excluded that the prospect of a non referred event can be truly understood and tested for with any certainty. As we all know , the presence of one factor ( disease ) does not exclude by its presence , the possibility of interruptions to and irritations of normal neural mechanisms that are not disease related.
_____________________________
Ubi est mea anaticula cumminosa?
The Grand Pediculator
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RE: Information Exchange: Adhesive Capsulitis - May 13, 2008 6:40:28 AM
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SJBird55
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Ginger, I don't quite think your idea would be as helpful as you think.
a. definite localized injury to shoulder joint
b. some type of orthopaedic/biomechanical factor whether degenerative in nature or genetic in nature
c. referred pain from internal organs or from some "silent" disease process
d. some type of movement impairment where imbalances in mobility and stability occur or where motor control is compromised
e. situations in which the thoracic and/or cervical spine seem to be some type of factor
f. situations where peripheral neural structures may be some type of factor
g. central processing changes
That's the best I can come up with this morning. The problem is that patients may have overlapping within those categories. For example, a patient may have a mixture of a, b and d occurring or maybe a combination of b and e. Or what about a initially and then g? We don't have a nice succinct way to analyze the the various potentials and then weight the contribution of the various potentials to the current complaint. Which then means we don't have the insight to know the most efficient and effective route to take to address situations with multiple variables.
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RE: Information Exchange: Adhesive Capsulitis - May 13, 2008 7:41:03 AM
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ginger
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From: Melbourne Victoria
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Birdy, seems like your a. and b. would fit within the not too narrow confines of my b. while the others are all a.
_____________________________
Ubi est mea anaticula cumminosa?
The Grand Pediculator
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RE: Information Exchange: Adhesive Capsulitis - May 13, 2008 8:09:32 AM
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TexasOrtho
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quote:
ORIGINAL: SJBird55
psst... Rod, just a small hint. Ginger is a he.
whoops...sorry about that ginger. I have a couple of questions for you I'll post later on regarding your treatment approaches.
< Message edited by TexasOrtho -- May 13, 2008 8:27:24 AM >
_____________________________
Rod Henderson, PT
Board Certified Orthopedic Specialist (or Super-Freak)
Certified Strength and Conditioning Specialist
www.texasorthopedics.blogspot.com
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RE: Information Exchange: Adhesive Capsulitis - May 13, 2008 8:13:09 AM
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Shill
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From: Madison WI USA
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Ginger,
How does your theory of all that ails being spinal nerve/facet root related compare to the "nerve interference" idea bastioned by subluxation based chiropractors?
Inquiring minds want to know.
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RE: Information Exchange: Adhesive Capsulitis - May 13, 2008 12:56:00 PM
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TexasOrtho
Posts: 386
Joined: December 22, 2007
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quote:
ORIGINAL: ginger
Using my outcomes and the observations of my students and patients , I wonder if the classification of non injury related shoulder problems could be as follows.
Subset a. Referred events from the upper spine , leading to shoulder pain, altered sensations of the upper limb along with some progressive limits to shoulder ROM, inhibition to normal patterns of muscular recruitment and the possibility of inflammatory 'disease' to shoulder synovial membranes.
I think these are widely recognized constructs of regional interdependence that have previously been documented.
quote:
Subset b. Other.( spontaneous tears, capsular inclusions, bony deformity, known hyperirritable disease conditions etc)
Subset a. would account for 90 percent ( or thereabouts ) of those who I treat.
What type of physician typically sends you patients? Or do you have direct access? If nine out of ten patients with cervicobrachial syndrome is being misdiagnosed as shoulder capsulitis by the referring physician, I'd have serious issues with the doctor.
quote:
The trouble is , those in subset b. would and ought to also be included in subset a..
This is a big problem with your proposed classification system. We'd need to reorganize the subsets if two different subsets have too many overlapping characteristics.
quote:
That is , the likelihood of a referred event giving rise to distal pain etc is very high, certainly enough to appear in my own priority list as needing to be addressed a priori. It is really only after such matters have been excluded that the prospect of a non referred event can be truly understood and tested for with any certainty. As we all know , the presence of one factor ( disease ) does not exclude by its presence , the possibility of interruptions to and irritations of normal neural mechanisms that are not disease related.
I don't see any inherent risk to this approach so why not include it in the evaluation process. However, I'm not sure how this is necessarily unique or different to the way many of us trained in orthopedics see things. I may be underestimating my skill set or overestimating the skills of others, but the concept of proximal or regional interdependence has been in place for years.
I think the risk comes from getting wrapped up in a preconceived notion of whats happening or a belief system vs dispassionately assessing the patients presentation. Sometimes the patients presentation is a result of the centrally mediated relationships you mention. Sometimes it simply is what it is regardless of our preconceptions. I think the skilled therapist can ascertain the difference.
< Message edited by TexasOrtho -- May 13, 2008 8:08:51 PM >
_____________________________
Rod Henderson, PT
Board Certified Orthopedic Specialist (or Super-Freak)
Certified Strength and Conditioning Specialist
www.texasorthopedics.blogspot.com
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RE: Information Exchange: Adhesive Capsulitis - May 13, 2008 9:37:56 PM
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ginger
Posts: 636
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From: Melbourne Victoria
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Rod , I think we are on the same page
Birdy, horses of any colour still eat hay, it' is only when one turns out to be a camel that the wrangler gets a little unnerved.
Shill , chiropractors are hampered , to a large degree , by a business model that makes them apologists for short term effects like manipulation. Unfortunately , even where their thinking about the relationship between the spine and distal problems may be correct,their methods fall short of effectiveness. This is particularly so when the older style chiro continues to believe and remain connected to the subluxation story. I don't believe they are short on smarts.
Manipulation will not reliably turn off protective responses leading to nerve irritation leading to distal complaints, CM does . Cm does not fit well with the chiro business model for two important reasons. Restoring pain free normal spinal MOBILITY is a way for the practitioner to become redundant. Doing so in a clinical environment where each treatment , to be fully effective , may take thirty to forty minutes , is anathema to a business that relies on short treatments with many repeats.
I have attempted to reach out to discuss Cm and the philosophy of therapist redundancy with an assortment of chiros at conferences at lectures I have conducted . As a group they are appear to be not interested in either testing their beliefs , or adopting what I would offer is a more user friendly apprach with advantages for consumers.
_____________________________
Ubi est mea anaticula cumminosa?
The Grand Pediculator
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