6. 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)
7. 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)
8. 1° Frozen
Post -traumatic/-operative stiffness
Antalgic sh (pain & muscle drivers)
1° Frozen
Post -traumatic/-operative stiffness
diagnosis
(Walton & Russel, 2015)
12. 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
13.
14. 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
15. 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
16. 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
Notes de l'éditeur
Apart form only our clinical history taking & our clinical objective evaluation we have radiology etc to eliminate cause in those in the boxes. Challenge is these 3 at the bottom. Post trauma & operative is ass with op & trauma – obvious – uniplanar often – unless long period past then may be global stiffness ie multi planar stiffness.
Apart form only our clinical history taking & our clinical objective evaluation we have radiology etc to eliminate cause in those in the boxes. Challenge is these 3 at the bottom. Post trauma & operative is ass with op & trauma – obvious – uniplanar often – unless long period past then may be global stiffness ie multi planar stiffness.
GUESS THEPHASE
PHASE ONE BREAK THE CYCLE ADDRESS PAIN AS PER PREVIOSU SLIDE
SPASM dry needling STR esp subscapularis muscle etc.
Try to get hem to move. – GHJ PAMS grade 1 & 2.
GUESS THEPHASE
PHASE ONE BREAK THE CYCLE ADDRESS PAIN AS PER PREVIOSU SLIDE
SPASM dry needling STR esp subscapularis muscle etc.
Try to get hem to move. – GHJ PAMS grade 1 & 2.
GUESS THEPHASE
PHASE ONE BREAK THE CYCLE ADDRESS PAIN AS PER PREVIOSU SLIDE
SPASM dry needling STR esp subscapularis muscle etc.
Try to get hem to move. – GHJ PAMS grade 1 & 2.