By Afrana Syiemlieh
Krupanidhi College of Physiotherapy
The HOD (Dr.Deepshika Barua)
Little Sisters of the Poor
ANATOMY OF THE SHOULDER
The shoulder is made up of three bones: the clavicle (collarbone), the scapula (shoulder blade), and the humerus (upper arm bone) as well as associated muscles, ligaments and tendons. The articulations between the bones of the shoulder make up the shoulder joints. The joint cavity is cushioned by articular cartilage covering the head of the humerus and face of the glenoid. The joint is stabilized by a ring of fibrous cartilage surrounding the glenoid called the labrum.
Four short muscles originate on the scapula and pass around the shoulder where their tendons fuse together to form the rotator cuff. Two bursae cushion and protect the rotator cuff from the bony arch of the acromion and allow smooth movement of the joint- subacromial bursa and subdeltoid bursa.
JOINTS OF THE SHOULDER
There are 3 joints of the shoulder-
CAPSULE OF THE SHOULDER JOINT LIGAMENTS OF THE SHOLDER JOINT
MOVEMENTS OF THE SHOULDER
1. Abduction: 150 degrees
2. Adduction: 150-0 degrees
3. Forward flexion: 180 degrees
4. Extension: 45-60 degrees
5. Rotation (test with elbow flexed to 90 degrees)
1. External Rotation: 90 degrees
2. Internal rotation: 70-90 degrees
DEFINITION OF FROZEN SHOULDER
Frozen shoulder, medically referred to as adhesive capsulitis, is a disorder in which the shoulder capsule, the connective tissue surrounding the glenohumeral joint of the shoulder, becomes inflamed and stiff, and grows together with abnormal bands of tissue, called adhesions, greatly restricting motion and causing chronic pain. A frozen shoulder is a shoulder joint with significant loss of its range of motion in all directions. The range of motion is limited not only when the patient attempts motion, but also when the doctor attempts to move the joint fully while the patient relaxes. Frozen shoulder is defined as a clinical syndrome characterised by painful restriction of both active and passive shoulder movements due to causes within the shoulder joint or remote (other parts of the body). • Frozen shoulder is the result of scarring, thickening, and shrinkage of the joint capsule. • RISK FACTORS
• Frozen shoulder occurs much more commonly in individuals with diabetes, affecting 10% to 20% of these individuals. Other medical problems associated with increased risk of frozen shoulder include: hypothyroidism, hyperthyroidism, Parkinson’s disease, and cardiac disease or surgery. •
CAUSES OF FROZEN SHOULDER
Most cases of frozen shoulder are idiopathic(Primary frozen shoulder), but some maybe associated with certain factors such as diabetes mellitus, spinal lesions, trauma or prolonged immobilisation of the shoulder for some other cause(Secondary frozen shoulder). Any injury to the shoulder can lead to frozen shoulder, including tendinitis, bursitis, and rotator cuff injury. Frozen shoulders occur more frequently in patients with diabetes, chronic inflammatory arthritis of the shoulder, or after chest or breast surgery. Long-term immobility of the shoulder joint can put people at risk to develop a frozen shoulder. It is recognised that frozen shoulder follows a definite sequence that occurs in three main stages. These have been described by Cyriax as follows: STAGE 1(stage of pain): patient complains of acute pain, decreased by movements, external rotation greatest followed by loss of abduction and then forward flexion. Internal rotation is least affected. This stage last for 10-36weeks. STAGE 2(stage of stiffness): Here, pain gradually decreases and the patient complains of stiff shoulder. Slight movements are present. STAGE...
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