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Stage 1: Capsular pattern of motion (loss ER and abduction) present, described as achy at rest and sharp at extremes of ROM, pain palpation anterior and posterior capsules, pain radiates to deltoid insertion
LOSS OF MOTION
Stage 2: Pain palpation anterior and posterior capsules, pain radiates to deltoid insertion, loss of motion in all planes, pain in all parts of the range
FREEZING
Stage 3: Often report painful phase that has resolved but continue to have stiff shoulder, poor scapulohunmeral rhythm during arm elevation, dominance upper trapezius, decreased inferior glide of the GH joint
FROZEN
Stage 4: Slow/ steady recovery of ROM, capsular end-feel reached before pain
THAWING Assess for impairments of capsule, ligaments, tendinous structures
occurs as continuum by staged progression of pain and mobility deficits
gradual and progressive onset of pain & loss of AROM/PROM elevation, rotation
normalize patients impairments
outcome measure: DASH, ASES, SPADI,
activity limitations and participation restrictions
Intervention: Corticosteroid injections, patient education natural course of disease, promote activity, pain free ROM, stretching, modalities such as ultrasound, Estim, joint mobilization, translational manipulations, stretching exercises Aka Complex Regional Pain Syndrome
Poorly understood
Usually associated with nerve trauma
I (acute): burning pain, tenderness, swelling, vasomotor changes
II: persistent aching, swelling w/ hardening, skin/nail bed changes
III: skin and subcutaneous strophy, development contractures
Intense, prolong pain out of proportion to cause
Night pain
Pyschological disturbances
Discoloration
Hypersensitivity of skin
Moist skin
Chronic edema
Atrophy
Weakness
Red, Warm, swollen, burning, sweating,
try not to touch involved lim b @ first
encourage relaxation
ROM
MIrror therapy
get other healthcare people involved! 