shoulder internal rotation restricted

[umerphysio]

Hello all Physios,

I have a patient with frozen shoulder. I worked hard with him and his ranges are improving except internal rotation. How can i improve his internal rotation?

Kindly help me out

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[linbin]

hi friend,
from my experience with frozen shoulder subjects,the best way to improve internal rotation is to give posterior glide to humeral head
if you can combine distraction +posterior glide,it will be more effective.
posterior capsular stretching also helps a lot

[umerphysio]

thanks linbin. i will try your suggestions.
best regards
umer physio

[linbin]

hi umer,
you can start giving posterior glide in scaption.then take the arm gradually into other planes,if the pain is severe.
even adding gradual internal rotation,while giving glide posteriorly will address the area specifically
keep posting the progress
cheers

[physiobob]

Hi umerphysio,

You might not know what "Scaption is"? Scaption is an abduction (or adduction) movement in the scapular plane. i.e it is not like true abduction where the arms comes out to the side. The scapular faces slightly forward of that at it lies on the rib cage (slightly different in each person). The arm therefore "abducted" in that direction is scaption.

You might also try releasing any trigger type points or tender sports in the muscles on the scapula, infraspinatus and the teres group. Also under the axillar to get at subscapularis. If the humeral head is lying rather anterior in the joint perhaps there is a mechanical block or labral tear in there. Has there been any investigations? A true shoulder will take 18 months to 2 years to resolve. This has been improved with things like hydrodilation of the capsule.

All that said Frozen Shoulder is an general term. It is often misdiagnosed when in fact there is underlying pathlogy such as trauma and or rotator cuff damage.

[umerphysio]

hi,
thanks for your very informative reply.your reply is very helpful. yes that patient has a trauma history on the effected shoulder 3 years ago. he came to me with much pain in his shoulder but now he is pain free.today i found some trigger points over scapular region and tried to break them will see the results tomorrow. i hope it will work.
can i ask you for help directly in the future?

best regards
Umer Physio

[physiobob]

i found some trigger points over scapular region and tried to break them will see the results tomorrow.

If you release anything that will facilitate more range you will see the results there and then and shouldn't have to wait until the next day

[umerphysio]

If you release anything that will facilitate more range
hello sir,it worked and the ranges are getting improve quickly. thanks for your kind suggestions u have made to my question.

[smshaffe]

did posterior glide work on the patient? if not, and something else did, what was it? if nothing worked. what happened to the patient?

[umerphysio]

did posterior glide work on the patient? if not, and something else did, what was it? if nothing worked. what happened to the patient?

hi,
posterior glide didn't work. i found some trigger points in scapuler region and tried to release them.that worked little bit but the internal rotation is still there......but the pain decreased

[physio.irl]

Well done on the success trigger point work!
You will also need the patient to do some slow sustained stretching at home - like the stretches in the link here - in particular A and B.
Posterior Capsular Contracture of the Shoulder -- Bach and Goldberg 14 (5): 265 Figure A0008404FIG9 -- Journal of the American Academy of Orthopaedic Surgeons

Ask them to heat up the shoulder first - hotpack/warm shower, and do these stretches assisted with the other hand (like the pictures), or put a weight in the affected hand and use gravity to gradually increase the range of internal rotation (patient supine, shoulder elbow at 90), over a 15-20 minute period.

Remember once you gain new range you need to strengthen in that range.

[smshaffe]

if the trigger point treatment only worked a little then it isn't the answer, right?

are we talking about real frozen shoulder or just someone who is really stiff? how long have they had the frozen shoulder? really, the research out there says you should mobilize and stretch the joint and surrounding tissue. maitland, kaltenborn, and others all offer really good mobilization techniques. true frozen shoulder often doesn't respond well to conservative treatment until it is at least 3 months old. then, treatment can slowly be made more aggressive. usually, full recover is expected unless the person is, for example, an uncontrolled diabetic. in fact, if they are a heavy smoker or drinker it may impact recovery too. and, if it is really chronic you have to consider that the AC, SC, and scapulothoracic areas may be involved. they may all need treatment. but, true adhesive capsulitis just regardless needs lots of shoulder joint mobilization.