scholarly journals A Thickened Coracohumeral Ligament and Superomedial Capsule Limit Internal Rotation of the Shoulder Joint: Report of Three Cases

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Masashi Koide ◽  
Junichiro Hamada ◽  
Yoshihiro Hagiwara ◽  
Kenji Kanazawa ◽  
Kazuaki Suzuki
Keyword(s):  
Internal Rotation ◽  
External Rotation ◽  
Adhesive Capsulitis ◽  
Arthroscopic Surgery ◽  
Frozen Shoulder ◽  
Severe Restriction ◽  
Manipulation Under Anesthesia ◽  
Coracohumeral Ligament ◽  
Joint Report

Adhesive capsulitis of the shoulder (also known as frozen shoulder) is a painful and disabling disorder with an estimated prevalence ranging from 2% to 5% in the general population. Although the precise pathogenesis of frozen shoulder is unclear, thickened capsule and coracohumeral ligament (CHL) have been documented to be one of the most specific manifestations. The thickened CHL has been understood to limit external rotation of the shoulder, and restriction of internal rotation of the shoulder has been believed to be related to posterior capsular tightness. In this paper, three cases of refractory frozen shoulder treated through arthroscopic release of a contracted capsule including CHL were reported. Two cases in which there is recalcitrant severe restriction of internal rotation after manipulation under anesthesia (MUA) were finally treated with arthroscopic surgery. Although MUA could release the posterior capsule, internal rotation did not improve in our cases. After release of the thickened CHL, range of motion of internal rotation was significantly improved. This report demonstrates the role of the thickened CHL in limiting the internal rotation of the shoulder. We highlight the importance of release of thickened CHL in addition to the pancapsular release, in case of severe limitation of internal rotation of shoulder.

scholarly journals Factors Affecting the Outcomes of Arthroscopic Capsular Release for Idiopathic Adhesive Capsulitis

2019 ◽  
Vol 7 (9) ◽  
pp. 232596711986762 ◽  
Author(s):  
Syed M. Rizvi ◽  
Ahmed J. Harisha ◽  
Patrick H. Lam ◽  
George A.C. Murrell
Keyword(s):  
Range Of Motion ◽  
Internal Rotation ◽  
External Rotation ◽  
Adhesive Capsulitis ◽  
Linear Regression Analysis ◽  
Frozen Shoulder ◽  
Level Of Evidence ◽  
Duration Of Symptoms ◽  
Capsular Release ◽  
Arthroscopic Capsular Release

Background: Arthroscopic capsular release has been shown to provide excellent short- and long-term outcomes in patients with idiopathic frozen shoulder. Some surgeons delay surgery in the belief that operating in the early stages of adhesive capsulitis results in a poorer prognosis. However, it is unclear which factors, particularly the stage of the disorder, affect the surgical outcome of this procedure. Hypothesis: Patients who undergo capsular release during the early symptomatic stage of idiopathic adhesive capsulitis would have less improvement in range of motion compared with those who undergo surgery at a later stage. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 189 shoulders with idiopathic adhesive capsulitis that underwent arthroscopic capsular release were evaluated. All patients completed a L’Insalata questionnaire and had their range of motion and strength tested prior to surgery and at 1, 6, and 12 weeks and 6 months post–capsular release. Post hoc, patients were grouped by whether they had symptoms lasting <10 months (shorter symptoms group; n = 131) or ≥10 months (longer symptoms group; n = 38). Multiple linear regression analysis was performed to determine which preoperative factors were independently associated with a favorable outcome. Results: Patients in the shorter symptoms group were more restricted prior to surgery than were those in the longer symptoms group (mean ± SEM: external rotation, 17° ± 2° vs 27° ± 4° [ P = .04]; abduction, 78° ± 3° vs 92° ± 6° [ P = .04]; internal rotation, S3 ± 1 vs S1 ± 1 [ P = .03]). The shorter symptoms group had greater postoperative improvement in internal rotation (from S3 ± 1 preoperatively to T12 ± 1 vertebral levels) compared with the longer symptoms cohort (from S1 ± 1 to L2 ± 1) ( P = .02). Conclusion: Patients with a frozen shoulder and a duration of symptoms <10 months made greater improvements in internal rotation and had similar final results for flexion, abduction, and external rotation following arthroscopic capsular release when compared with patients who had a longer duration of symptoms, so there is no reason to delay surgery.

Rotator Cuff Training for Pitchers

1998 ◽  
Vol 7 (4) ◽  
pp. 285-299 ◽  
Author(s):  
Michael E. Powers
Keyword(s):  
Rotator Cuff ◽  
Internal Rotation ◽  
High Speed ◽  
External Rotation ◽  
Shoulder Abduction ◽  
Muscular Endurance ◽  
Shoulder Injuries ◽  
Three Stages ◽  
Two Stages

This paper reviews the role of the rotator cuff during two key phases of the pitching sequence and presents a training program for these muscles. The program uses a periodization design consisting of three stages, beginning with a high-resistance/low-repetition eccentric strengthening stage. This is followed by a low-resistance/high-repetition stage for training muscular endurance. The core exercises for these two stages are prone external rotation in the 90/90 position, prone horizontal abduction, side-lying D2 flexion pattern, supine internal rotation in the 90/90 position, prone elevation with 100° of shoulder abduction and external rotation, and standing scapular plane elevation. The final stage of the program uses high-speed functional exercises: 90/90 external rotation, 90/90 internal rotation, D2 PNF flexion pattern, D2 PNF extension pattern, supine plyometric 90/90 internal rotation with a medicine ball, and the “arm whip” through the D2 PNF flexion pattern. The goal of this program is to prepare the muscles for the stresses of pitching and prevent shoulder injuries.

scholarly journals Does Scapular Motion Regress with Aging and is It Restricted in Patients with Idiopathic Frozen Shoulder?

2016 ◽  
Vol 10 (1) ◽  
pp. 80-88 ◽  
Author(s):  
Kazuhiro Endo ◽  
Junichiro Hamada ◽  
Kazuaki Suzuki ◽  
Yoshihiro Hagiwara ◽  
Takayuki Muraki ◽  
...  
Keyword(s):  
Statistical Difference ◽  
External Rotation ◽  
Statistical Significance ◽  
Frozen Shoulder ◽  
Severe Restriction ◽  
Age Related ◽  
Posterior Tilt ◽  
Asymptomatic Subjects ◽  
Anterior Posterior ◽  
Scapular Motion

Purposes:It has been reported that the amount of posterior tilt and upward rotation in scapular motions decreases with aging. The purposes of the current study were to investigate age related scapular motion regression and scapular restriction in patients with idiopathic frozen shoulder (IFS).Methods:The groups were recruited as follows: two groups of 50 asymptomatic subjects aged in their twenties and fifties, and 56 patients with IFS. We passively moved the scapula toward 8 directions: elevation/depression; upward/downward rotation; external/internal rotation; and anterior/posterior tilt. The grading of scapular motion was ranged from 0 to 3 (3, normal; and 0, severe restriction) and the score for each direction and the total aggregated score for all directions were calculated.Results:Scapular restriction was present in 3 subjects (6%) in the normal 20s group, 10 (14%) in the 50s group, and 51 (91%) in the IFS group. The total score between the normal 20s and 50s groups did not show statistical difference; however, greater significance was present between the normal 50s group and the IFS group (p < 0.01). There was statistical significance in depression (p < 0.01), downward rotation (p < 0.01), and posterior tilt (p < 0.01) among the 3 groups.Conclusion:Depression, downward rotation, and posterior tilt substantially regress with aging. Scapular motions towards depression, downward rotation, external rotation, and posterior tilt are severely restricted in the IFS group.

scholarly journals PREVALENCE AND MANAGEMENT OF THE DIABETIC FROZEN SHOULDER

2020 ◽  
Vol 8 (10) ◽  
pp. 944-954
Author(s):  
Niraj Kumar ◽  
Keyword(s):  
Functional Ability ◽  
External Rotation ◽  
Adhesive Capsulitis ◽  
Frozen Shoulder ◽  
Treatment Strategies ◽  
Insidious Onset ◽  
Group A ◽  
Shoulder Syndrome ◽  
Shoulder Condition ◽  
Group B

The term frozen shoulder was first introduced by Codman in 1934. He described a painful shoulder condition of insidious onset that was associated with stiffness and difficulty sleeping on the affected side. Codman also identified the marked reduction in forward elevation and external rotation that are the hallmarks of the disease. Long before Codman, in 1872, the same condition had already been labelled periarthritis by Duplay. In 1945, Naviesar coined the term adhesive capsulitis. [2] The pathophysiology of idiopathic adhesive capsulitis (frozen shoulder) is poorly understood. Most authors have reported various degrees of inflammatory changes in the synovial membrane. Adhesions between the shoulder capsule and the humeral head have been noted by some, but not all, authors. [4] The aetiology of periarthritis of the shoulder, however, is not clearly understood. Amongst the factors suggested are trauma myocardial infarction hemiplegia, pulmonary tuberculosis, thyrotoxicosis, cerebral tumour, and epilepsy. [7] Subjects with Frozen Shoulder Syndrome group A treated with ERM and MWM and group B treated with MRM. The duration of each treatment was 3 weeks. There was an improvement in mobility and functional ability at 12 weeks in subjects treated with the 3 mobilization techniques. Comparing the effectiveness of the 3 treatment strategies in subjects with unilateral Frozen Shoulder Syndrome, ERM and MWM were more effective than MRM in increasing mobility and functional ability. [22].

scholarly journals Role of Phonophoresis in Management of Adhesive Capsulitis (Frozen Shoulder)

2014 ◽  
Vol 13 (2) ◽  
pp. 21-27
Author(s):  
Sunam Kumar Barua ◽  
Sohely Rahman ◽  
Prashanta Kumar Chakrabarti ◽  
Zahangir Alam
Keyword(s):  
External Rotation ◽  
Adhesive Capsulitis ◽  
Frozen Shoulder ◽  
Medical College Hospital ◽  
Physical Medicine ◽  
College Hospital ◽  
Female Ratio ◽  
Medical College ◽  
Group A ◽  
Group B

This prospective study was performed in the department of Physical Medicine, Dhaka Medical College Hospital (DMCH), Dhaka for a period of 6 months to see the effect of phonophoresis (Ultrasound therapy with Naproxen gel) on adhesive capsulitis. During this period 240 (4% of total patients) patients were diagnosed as adhesive capsulitis of shoulder in outpatient department, Physical Medicine, Dhaka Medical College Hospital. Sixty patients were selected for the study and divided them into two groups. In group A, patients were treated with phonophoresis and exercises in contrast with group B patients who were treated with same exercises without phonophoresis for same duration. Patients in both groups were followed up weekly for consecutive six weeks. The mean age of the patients in this study was 51.73 ± 10.01 year, with a range of 35 to 70 years. Out of sixty patients 31 (51.7%) were male and 29 (48.3%) were female. The male: female ratio was 1.07: 1. Among 60 patients, 27 (45%) were housewives, 20 (33.3%) service holders (official job), 4 (6.7%) businessmen, 1 (1.7%) teacher and 8 (13.3%) retired persons. In this study 53.3% patients had right shoulder involvement and rest of them (46.7%) had left sided involvement. Pain was improved just after initiation of treatment and it was completely alleviated in group A patients after 6th week, on the contrary although pain was increased after 1st week of treatment thereafter it was gradually decreased but it was not completely alleviated in group B patients at the end of the study. All sorts of range of motions (abduction, internal rotation on abduction, external rotation on abduction) of affected shoulder were improved more rapidly in group A compared to group B patients. Shoulder pain and disability index (SPADI) were significantly reduced in group A compared to group B patients.DOI: http://dx.doi.org/10.3329/cmoshmcj.v13i2.21057

Shoulder hydrodilatation for primary, post-traumatic and post-operative adhesive capsulitis

2020 ◽  
pp. 175857322097717
Author(s):  
Daoud Makki ◽  
Mustafa Al-Yaseen ◽  
Fayaz Almari ◽  
Puneet Monga ◽  
Lennard Funk ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Outcome Measures ◽  
Glenohumeral Joint ◽  
External Rotation ◽  
Adhesive Capsulitis ◽  
Frozen Shoulder ◽  
Capsular Release ◽  
Arthroscopic Capsular Release ◽  
Number Of Patients ◽  
Post Traumatic

Background Adhesive capsulitis (frozen shoulder) is characterised by pain and loss of range of motion of the glenohumeral joint. It can be present as primary (idiopathic) or secondary to surgery, trauma or other conditions that restrict the use of the shoulder joint. Various treatment options have been adopted including physiotherapy, manipulation under anaesthetic, hydrodilatation and arthroscopic or open capsular release but the optimal form of management remains uncertain. Objectives The purpose of the study was to assess the clinical outcome of glenohumeral hydrodilatation in three cohorts of patients with different aetiologies with adhesive capsulitis. Study design & methods We carried out a retrospective study of patient who underwent hydrodilatation for adhesive capsulitis between 2013 and 2015. The procedure was performed by a specialist musculoskeletal radiologist under radiological guidance. The injection consisted of steroids, local anaesthetics and NaCl solution with a target volume around 35 mL. Our outcome measures were range of motion, and pre- and post-operative pain. Patients were divided into three groups based on the presumed cause of their stiffness: idiopathic, post-traumatic and post-surgical. Results Two hundred fifty patients were included, with a mean age of 59 years (range: 20–79). Of these, 180 had idiopathic primary adhesive capsulitis (27 were diabetic), 23 were post-traumatic, and 20 following surgical procedures. Thirty-four required further intervention following initial hydrodilatation with 8 undergoing repeat hydrodilatation, and 26 requiring arthroscopic capsular release. The diabetic group accounted for 16 capsular releases and 4 repeat procedures, while the idiopathic group accounted for 9 and 4, respectively. One patient required capsular release in the surgical group. An improvement was recorded in ROM in all groups with mean abduction improving from 59° to 110°, flexion from 50° to 120° and external rotation from 20° to 50°. With regards to pain, the majority showed an improvement from severe or moderate pain to no or mild pain. Conclusions Results show that hydrodilatation resulted in an improvement in all outcome measures, with only a small number of patients, especially those with diabetes, needing further procedures or showing no improvement in range of motion and pain. There was no difference between the post-traumatic and post-surgical groups.

scholarly journals A comparative study on the effectiveness of Mulligan mobilization versus Positional release therapy technique in patients with Adhesive capsulitis

2021 ◽  
Vol 12 (1) ◽  
pp. 1-5
Author(s):  
Chandrasekaran K ◽  
Sundaram M S ◽  
Senthil Selvam P ◽  
Viswanath Reddy A ◽  
Senthilkumar S ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Internal Rotation ◽  
Functional Activity ◽  
External Rotation ◽  
Adhesive Capsulitis ◽  
Shoulder Range Of Motion ◽  
Release Technique ◽  
Group A ◽  
Group B ◽  
Shoulder Range

Adhesive capsulitis is a painful condition in which the movement of the shoulder becomes limited and functional activity is affected. Adhesive capsulitis occurs when the shoulder joint capsule become thick, stiff and inflamed. The aim of the study is to compare the effectiveness of Mulligan movement with mobilization versus Positional release technique on shoulder range of motion and functional activity in patients with adhesive capsulitis. 30 patients were randomly divided into two groups. Group A (N = 15) received Mulligan mobilization technique and Group B (N = 15) received positional release therapy. The shoulder range of motion (Abduction, External rotation, Internal rotation) was measured by goniometer, the functional activity by SPADI questionnaire. The results showed that significant differences in shoulder ROM Abduction (t = 14.18, p = 0.000), Internal rotation (t = 13.80, p = 0.000), External rotation (t = 15.87, p = 0.000) and SPADI questionnaire (t = 13.94, p = 0.000) were observed in group A patients when compared to group B. In conclusion the Mulligan mobilization technique was effective to improve the shoulder ROM and reduce functional disability in patients with adhesive capsulitis compared to Positional release technique.

scholarly journals Shoulder Muscle Isometric Strength and Active Range of Motion in Patients With Frozen Shoulder Syndrome After Manipulation Under Anesthesia

Medicina ◽  
2012 ◽  
Vol 48 (7) ◽  
pp. 49
Author(s):  
Jelena Sokk ◽  
Helena Gapeyeva ◽  
Jaan Ereline ◽  
Mati Merila ◽  
Mati Pääsuke
Keyword(s):  
General Anesthesia ◽  
Range Of Motion ◽  
Maximal Voluntary Contraction ◽  
External Rotation ◽  
Frozen Shoulder ◽  
Voluntary Contraction ◽  
Manipulation Under Anesthesia ◽  
Shoulder Muscle ◽  
Active Range Of Motion ◽  
Shoulder Syndrome

Background and Objective. Frozen shoulder syndrome (FSS) causes pain and restriction of movement in the shoulder. The aim was to assess changes in shoulder muscle isometric maximal voluntary contraction (MVC) force and active range of motion (AROM) in patients with frozen shoulder syndrome (FSS) after manipulation under general anesthesia (MUA). Material and Methods. In total, 18 patients with FSS (9 women and 9 men) with a mean age of 53.6 years (SD, 9.7) participated in this study. MVC force of shoulder flexors, adductors, and internal and external rotators was measured by a handheld dynamometer. AROM in the same directions was measured goniometrically. The patients were screened according to the intensity of pain by day and at night. The data were collected before MUA and 1 and 6 months after MUA. A significant reduction in MVC force and AROM was noted before MUA in the involved extremity as compared with the uninvolved extremity (P<0.05). These parameters for the involved extremity were significantly increased 1 month after MUA (P<0.05). However, 6 months after MUA, MVC force and AROM did not differ significantly compared with the uninvolved extremity (P>0.05), whereas AROM of flexion and external rotation remained significantly reduced (P<0.05). A significant reduction in shoulder pain by day and at night was recorded 1 and 6 months after MUA (P<0.05). Conclusions. In the patients with FSS, the fastest improvement of MVC force and AROM occurred following the first month after MUA. However, 6 months after MUA, shoulder muscle MVC force for the involved extremity did not differ significantly as compared with the uninvolved extremity, whereas the shoulder AROM in flexion and external rotation remained lower.

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