SHOULDER

R OTATO R C U F F T E N D I N O PAT H Y
F R OZ E N S H O U L D E R
ROTATOR CUFF MUSCLES
 Rotator Cuff Tendinopathy (RCTN)

 Tendinitis , tendinosis, bursitis, impingement are all known as Tendinopathy.

Supraspinatus is the common tendon involved

 Symptoms -
• Gradual dull aching pain and tenderness in the area of the four rotator cuff tendon
• Associated with weakness of shoulder and scapular muscle and inability to move.
• Overhead reaching above 90°, reaching behind the back, lifting, and sleeping on the affected side is
painful.
• Local swelling may be seen
Risk Factor for Tendinopathy
•Adiposity
•Metabolic Disorders: Non-familial Hypercholesterolaemia, Diabetes
•Muscle Imbalance
•Decreased Flexibility
•Overweight
•Advancing Age
•Certain Sports (Repetitive Arm Motion)
•Occupational – heavy work, overhead work etc
ETIOLOGY
Clinical test for RCTN
• Empty Can test The patient stands up with his shoulders in 90°abduction, 30° horizontal
adduction and in complete end range rotation. The therapist fixates his hands on the upper arm of
the patient and provides a downward pressure while the patient tries to maintain his position.
•Hawkin’s Test, the patient stands with the shoulders abducted to 90° and internally rotates the
forearm. The presence of pain with movement is an indicator of a possible pathology.
• Modified Belly Press Test the patient stands or sits with the affected hand flat on the abdomen
and elbow close to the body. The patient needs to bring the elbow forward and straighten the
wrist. The final belly-press angle of the wrist needs to be measured with a goniometer. A belly-
press angle difference of 10° between affected and unaffected side indicates a tendinopathy.
MANAGEMENT
MEDICAL MANAGEMENT
NSAIDS
Corticosteroids injections
 Injection of platelet-rich plasma
Surgical
Open versus Arthroscopic surgery
PHYSIOTHERAPY MANAGEMENT
Patient education - avoid activities that increase pain and symptoms.
• Pain relieving modalities – Cryotherapy/ IFT / Ultrasound/ Kinesiotapping
• Isometric exercises for shoulder and scapular muscles within the pain limit.
• Manual Therapy – Graded mobilisation technique
• Postural correction – Cervical, thoracic and scapular exercises
• Graded scapular and shoulder strengthening exercises – Eccentric exercises
 FROZEN SHOULDER
Frozen Shoulder, often referred to as
Adhesive capsulitis (AC),
Characterized by initially painful and
 later progressively restricted active and
passive glenohumeral (GH) joint range of
motion with spontaneous complete or
nearly-complete recovery over a varied
period of time.
Frozen Shoulder

Extremely painful condition

Triggered by mild injury to the shoulder
May be associated with high Diabetes, cholesterol, heart disease.
The ligament and capsule becomes inflamed, swollen and
contracted and looses its normal elasticity

In clinical practice it can be very challenging to differentiate early

stages of Frozen Shoulder from other shoulder pathologies.[1]
 STAGES - Frozen shoulder typically develops slowly in three stages

•Freezing stage. Any movement of the shoulder causes pain, and the
shoulder's ability to move becomes limited. This stage lasts from 2 to 9
months.

•Frozen stage. Pain might lessen during this stage. However, the shoulder
becomes stiffer. Using it becomes more difficult. This stage lasts from 4 to
12 months.

•Thawing stage. The shoulder's ability to move begins to improve. This

stage lasts from 5 to 24 months.

For some people, the pain worsens at night, sometimes disrupting sleep.
 CAUSES

•Idiopathic – Capsule thickens and tightens around the shoulder joint restricting the
ROM ( ACTIVE and Passive ROM).

•Age – Above 40 years

•Gender - Females and males are both equally affected

•Reduced Mobility / Immobility – Secondary to Rotator cuff injury, fracture, stroke,

recovery from surgery

•Systemic disease – Diabetes, Thyroid

DIFFERENTIAL DIAGNOSIS
SPECIAL TEST
 DIAGNOSIS
 To diagnose frozen shoulder your doctor will discuss patients symptoms
and review the medical history.

 Conduct a physical exam of your arms and shoulders:

• Assessment of active and Passive ROM – flexion , extension, Internal
and External rotation, Abduction and adduction.
• Assessment of strength of the Upper limb and shoulder girdle muscles
• Special test - Shoulder special tests are
useful for identifying shoulder pathology such as rotator cuff tears,
impingement, instability, biceps injury, and labral tears

Investigation like – Xray, MRI are done to rule out other problems like Rotator
cuff ,arthritis.

Check the link for diagnosis of Frozen shoulder

https://www.youtube.com/watch?v=5zpXbvEf9j0
TREATMENT
Medication – to reduce inflammation and Pain
Physiotherapy –
◦ Cell repair / IFT / Hot packs - to reduce pain and inflammation
◦ Shoulder mobilisation – Maitland , Mulligan
◦ Range of motion exercises - Pendular exercises, Wand exercises.
◦ Strengthening exercise for shoulder girdle exercises

Surgical and Other procedure

◦ Steroids injection - Injecting steroids in the joint to reduce inflammation
◦ MUGA – Manipulation under general anaesthesia, done to loosen the tight tissue around the joint
◦ Surgery – Rare for frozen shoulder. Arthroscopy can be done to loosen the scar tissue
EXPECTATION SETTING FOR FROZEN SHOULDER
PATIENTS ??
• Pain will be the main problem initially with disturbed sleep and function
•As pain decreases stiffness will increase overtime and cause limitation in the shoulder
movements
• Advising the patient to be active is important but continuing the activity that increases pain
should be restricted
•Few patients will continue to report pain and stiffness for a year
•The average duration of Frozen shoulder is 24 months, may take upto 3 years.
THANK YOU