Wednesday, February 18, 2009

Frozen Shoulder Update

Various stretches have been introduced for the posterior shoulder; however, little quantitative analysis to measure stretching of the posterior capsule has been performed. Which further implies the biomechanical impacts of the stretching on the joints would vary. That further implies that the out comes on joint mobility of a stiff joint are different.

In clinical setting we want quick and more importantly less painful techniques that are easy to administer by the therapist. I personally have utilized the cyriax’s capsular stretching methods for a decade now. I am currently working on modified techniques of my own. To improve the hand behind the back my personal favorite is mulligan’s technique. However I have modified that too in my own way.

Currently I am treating 7-8 frozen shoulders a day in my clinic. Personal satisfaction is what I cherish most. But with satisfaction there comes dissatisfaction; I hope that’s true for any clinician who understands his patient’s plethora of suffering. I feel dissatisfaction also sometime erupts out of failure to provide adequate relief in few patients wihich acts as an impetus for furthering my current clinical knowledge. So I am in the constant look out for such papers that have a immediate clinical application.

I found one paper by Tomoki Izumi et al titled “Stretching Positions for the Posterior Capsule of the Glenohumeral Joint Strain Measurement Using Cadaver Specimens” published in AMERICAN JOURNAL OF SPORTS MEDICINE.

The summery of that paper is as follows:

According to the authors hypothesis, the current shoulder stretching program is not sufficient to stretch the entire posterior capsule.

Hence a controlled laboratory study using cadaver specimens was designed by the authors. They used 8 fresh-frozen cadaver shoulders (average age, 82.4 years), 8 stretching positions for the posterior capsule were simulated by passive internal rotation.

Stretching positions of 0°, 30°, 60°, and 90° of elevation in the scapular plane; 60° of flexion; 60° of abduction; 30° of extension; and 60° of flexion and horizontal adduction were adopted. Strain was measured in the upper, middle, and lower parts of the capsule.
They found:
1. Increase in strains of the upper, middle, and lower capsule with internal rotation at 0°, 30°, and 60° of elevation were statistically significant, respectively (P < .01). Other shoulder positions demonstrated no positive strain values.

2. Based on the results of this cadaver study, large strains on the posterior capsule of the shoulder were obtained at a stretching position of 30° of elevation in the scapular plane with internal rotation for the middle and lower capsule, while a stretching position of 30° of extension with internal rotation was effective for the upper and lower capsule.

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