Presented by Presented to

K M Amran Hossain
 Fahim Abrar Khan(Roll No:09)
BScPT, MScPT,CMU in MSK
 Tanzila Akter(Roll No:19) Ultrasonography.
Lecturer of Physiotherapy, BHPI
 Janhanara Akter(Roll No:21)
 Niama Akter Mim(Roll No:25)
 Jeorge Sourov Roy(Roll No:50)

Fahim Abrar Khan,

Tanzila Akter,
Janhanara Akter,
Niama Akter Mim,
Jeorge Sourav Roy, 1
3rd Year BScPT student, BHPI
Welcome to our
presentation

Fahim Abrar Khan,

Tanzila Akter,
Janhanara Akter,
Niama Akter Mim,
Jeorge Sourav Roy, 2
3rd Year BScPT student, BHPI
 Title

Immobilizational
Arthritis

Fahim Abrar Khan,

Tanzila Akter,
Janhanara Akter,
Niama Akter Mim,
Jeorge Sourav Roy, 3
3rd Year BScPT student, BHPI
 Learning outcome
History
Definition
Causative factors
Symptoms
Diagnosis criteria
Treatment
Physiotherapy Treatment

Fahim Abrar Khan,

Tanzila Akter,
Janhanara Akter,
Niama Akter Mim,
Jeorge Sourav Roy, 4
3rd Year BScPT student, BHPI
 History
The development and natural history of immobilization arthritis can
not be distinguished form those of traumatic arthritis. Again, there
are three phases in the progress of the disease. These phases are:-
• Painful phase
• Subsequent progressive stiffness phase
• Thawing phase
Altogether, it takes about a year for the lesion to recover
spontaneously and movement to return to normal.

Fahim Abrar Khan,

Tanzila Akter,
Janhanara Akter,
Niama Akter Mim,
Jeorge Sourav Roy, 5
3rd Year BScPT student, BHPI
 Definition
Immobilization refers to the process of holding a joint or bone in a

place with a splint, cast or brace. This is done to prevent an injured

area from moving while it heals.

And arthritis means inflammation of one or more of joint.

Immobilization arthritis is one kind of arthritis. Extend the duration

of immobilization that causes pain, stiffness of the joint and

limitation of the movement is called immobilization arthritis.

Fahim Abrar Khan,
Tanzila Akter,
Janhanara Akter,
Niama Akter Mim,
6
Jeorge Sourav Roy,
Fahim Abrar Khan,
Tanzila Akter,
Janhanara Akter,
Niama Akter Mim,
7
Jeorge Sourav Roy,
 Causative factors
• 25% patients with subarachnoid bleeding develop a frozen
shoulder, over an observation period of 6 months.

• Neurological condition such as Parkinson’s disease may

precipitate capsular stiffening.

• Arm disorder such as:- fracture of the elbow or humerus

develop post traumatic arthritis.

• Ischemic heart disease and shoulder arthritis.

Fahim Abrar Khan,

Tanzila Akter,
Janhanara Akter,
Niama Akter Mim,
Jeorge Sourav Roy, 8
3rd Year BScPT student, BHPI
 Symptoms

• Pain

• Swelling

• Deformity

• Instability

• Loss of function

• Decreased range of motion

Fahim Abrar Khan,
Tanzila Akter,
Janhanara Akter,
Niama Akter Mim,
Jeorge Sourav Roy, 9
3rd Year BScPT student, BHPI
 Diagnosis criteria
Patient’s medical history:-
Previous disorders of the inert structures.
Physical examination:
When capsular pattern is positive develops immobilizational
arthritis in the shoulder.
There are three stages of immobilization arthritis which can detect
the disorders

Fahim Abrar Khan,

Tanzila Akter,
Janhanara Akter,
Niama Akter Mim,
Jeorge Sourav Roy, 10
3rd Year BScPT student, BHPI
 Diagnosis criteria
Stage 1: Painful Phase:
i. Gradual onset, pain at rest
ii. Pain during movement
iii. Inflammatory sign- Positive
iv. Pain and limitation of movement increased
Stage 2: Stiffness Phase:
v. Pain diminished
vi. Limitation remains the same
Stage 3: Thawing phase:
vii.Limitation decreased
viii.Recover spontaneously and movement to return to
normal Fahim Abrar Khan,
Tanzila Akter,
Janhanara Akter,
Niama Akter Mim,
Jeorge Sourav Roy, 11
3rd Year BScPT student, BHPI
 Diagnosis criteria
• Clinical examination
Radiological findings: X-ray, MRI

Fahim Abrar Khan,

Tanzila Akter,
Janhanara Akter,
Niama Akter Mim,
Jeorge Sourav Roy, 12
3rd Year BScPT student, BHPI
 Treatment

The condition should never be encountered. It is verry important for

primary care physicians and physiotherapist to realize that

immobilized shoulder should be given gentle movement at least once

a day, in order to prevent the development of immobilization

shoulder arthritis.

In prevention it is sufficient to maintain the normal range of

movement, from the very beginning of immobilization.

Fahim Abrar Khan,
Tanzila Akter,
Janhanara Akter,
Niama Akter Mim,
Jeorge Sourav Roy, 13
3rd Year BScPT student, BHPI
 Physiotherapy Treatment

When the immobilization arthritis of shoulder develops then the

treatment should be given:

Stage 1:
• Treated with capsular stretching.

• Relative rest

• Electrotherapy- Ice, Ultrasound therapy (Prevent pain and

swelling)
Fahim Abrar Khan,
• Facilitated Exercise. Tanzila Akter,
Janhanara Akter,
Niama Akter Mim,
Jeorge Sourav Roy, 14
3rd Year BScPT student, BHPI
Capsular stretching

Fahim Abrar Khan,

Tanzila Akter,
Janhanara Akter,
Niama Akter Mim,
Jeorge Sourav Roy, 15
3rd Year BScPT student, BHPI
 Physiotherapy Treatment
Stage 2:

• Treated with stretching if the end feel is right

• Gliding

• Electrotherapy-Ultrasound therapy, Infrared Radiation, Hot

pack. (Prevent possible disuse atrophy)

Stage 3:

• Inra-articular injection of 20mg of triamcinolone.

• Distraction with Stage 3 treatment.

Fahim Abrar Khan,
Tanzila Akter,
Janhanara Akter,
Niama Akter Mim,
Jeorge Sourav Roy, 16
3rd Year BScPT student, BHPI
Capsular distraction

Fahim Abrar Khan,

Tanzila Akter,
Janhanara Akter,
Niama Akter Mim,
Jeorge Sourav Roy, 17
3rd Year BScPT student, BHPI
Intraarticular injection

Fahim Abrar Khan,

Tanzila Akter,
Janhanara Akter,
Niama Akter Mim,
Jeorge Sourav Roy, 18
3rd Year BScPT student, BHPI
 References
1.Cyriax JH. Textbook of Orthopaedic Medicine, vol I, Diagnosis and
Treatment of Soft Tissue Lesions. 8th ed. London: Baillière Tindall;
1982. p. 134.
2. Tveitå EK, Ekeberg OM, Juel NG, Bautz-Holter E. Range of shoulder
motion in patients with adhesive capsulitis: intra-tester reproducibility
is acceptable for group comparisons. BMC Musculoskelet Disord
2008;9:49.
3. Fritz JM, Delitto A, Erhard RE, Roman M. An examination of the
selective tissue tension scheme, with evidence for the concept of a
capsular pattern of the knee. Phys Ther 1998;78:1046–61.
4. Loyd JA, Loyd HM. Adhesive capsulitis of the shoulder:arthrographic
diagnosis and treatment. South Med J 1983;76(7):
5. Neviaser TJ. Arthrography of the shoulder. Orthop Clin North
Am1980;11(2):205–17.
6.Connell D, Padmanabhan R, Buchbinder R. Adhesive capsulitis: role
of MRI imaging differential diagnosis.
Fahim Abrar Eur
Khan, Radiol 2002;12(8):2100–6.
Tanzila Akter,
Janhanara Akter,
Niama Akter Mim,
Jeorge Sourav Roy, 19
3rd Year BScPT student, BHPI
“Thank you for your attention”