O slideshow foi denunciado.
Utilizamos seu perfil e dados de atividades no LinkedIn para personalizar e exibir anúncios mais relevantes. Altere suas preferências de anúncios quando desejar.

Physiotherapy for the Stiff Shoulder

465 visualizações

Publicada em

Physiotherapy for Frozen Shoulder by Dr Tanya Mackeznie. Presented at The Wilmslow Hospital for The Arm Clinic's #stiffshoulder event, 29th April 2016

Publicada em: Saúde e medicina
  • Seja o primeiro a comentar

Physiotherapy for the Stiff Shoulder

  1. 1. • OA • Locked posterior dislocation X-ray • Tumour • Infection • RA Red flags • M weakness (RC tears etc.) • Neurogenic MRI/US/N cdtn
  2. 2. HX of Uni - or multi - planar
  3. 3. PAINFULL PAIN = dominant feature = sever = at night FROZEN PAIN = slowly ↓ing = night p resolving =@ limit of ROM only Stiffness= dominant feature THAWING Pain = resolving ROM = ↑ing subjective (Walton & Russel, 2015)
  4. 4. ROM = grad loss esp ER AM vs. PM = but P limits ROM not stiffness PM End feel = spasm/empty/pain before resistance ROM = more global loss (only 40% had LAMB) (Rundquist 2003) AM vs. PM = AM=PM EROM & P simultaneous onset PM End feel = capsular/hard ROM = ↑ing AM vs. PM = AM=PM No EROM pain or P on OPress objective (Walton & Russel, 2015)
  5. 5. 1° Frozen Post -traumatic/-operative stiffness Antalgic sh (pain & muscle drivers) 1° Frozen Post -traumatic/-operative stiffness diagnosis (Walton & Russel, 2015)
  6. 6. orthopaedics greatest mystery
  7. 7. possibly non the wiser likely
  8. 8. Early phase keys PAIN SPASM IMMOBILISATION Break cycle PAIN: (moist heat/meds/etc…) SPASM: trigger pt or dry needle or STR esp subscap / gentle midrange sub max-isometrics ( CnR) IMMOBILISATION:AAROM/gentle PROM/Grade 1 & 2 PAMS of GHJ & EDUCATE, educate, educate, & keep educating NOT AGGRESSIVE
  9. 9. Mid phase keys EROM mobilisation & stretches can start Grade 3 & 4 GHJ PAMS & MWM Be specific – single plane better than multiple plane mobs (ER res thro abd ROM variable) Physiological stretching End range isometrics (PNF Contract relax) Isotonic exercises Pt home program NB +++++ EDUCATE regarding progression/regression risks - yoyo phase
  10. 10. Late phase As with mid phase Progress according to end feel LLLD = low load long duration stretches PAMS/MWM both single & MULTIPLE plane mobs Strengthen program
  11. 11. BUT: grps with ….better outcome but 441N-773N required to deform GHJ ST (Lee, 1999) GHJ PAMs = 39N. More likely restoring ghj kinematics not stretching non contractile structures