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FROZEN SHOULDERby :Yani Christina, M.D

DefinitionThe stiffness and limitation in shoulder movement, both active and passive, with pain at the scapulothoracic joint as well as at the glenohumeral joint.SynonimAdhesive capsulitisPeriarthritisPericapsulitisStiff shoulder.The shoulder complex

EtiologyUnknownRisk factor : - Trauma- Diabetes

Pathologic ConceptsStagesClinicalLoss/limitation of both active and passive Shoulder Range of Motion.Gradual onset of decreased shoulder function. Pain can occur when the shoulder moved or in the end of shoulder movement.

Differentials DiagnosisThe Rotator cuff tearsBicipitalis TendinitisTumor of Bone and Soft TissueImaging :X - Ray USGArthrographyTreatment1. Medicamentous :NSAID or Corticosteroid injection.2. Rehabilitation : Restoring passive and active range of motion.* Modality : heat therapy.* Home program : Stretches in all range of motion.3. SurgicalData base identity ( 14/10/09 )Name: Mrs. PWTSex : FemaleAge: 66 y.o.Address: SurabayaOccupational : HousewifeReligion: MoslemMarital status : MarriedReferred from Geriatric Out-patient Clinic with Osteoporotik shoulder D

Chief complaint: nyeri bahu kanan

History of present illness :

Pain at right shoulder since 3 years ago. Pain such as dull pain. Pain felt especially after she washed clothes and when she moves her arm to the back to wear clothes. Pain was relieved when she take a rest.She still can cooking.Pain is not radiating. There are no numbness and tingling sensation.

History of past illness :

Diabetes Mellitus and Hypertension known since 5 years ago, regularly controlled (every month) at Geriatric Outpatient clinic. No history of trauma

History of medication :

Glucodex2-1-0 Metformin0-0-2 Adalat oros1-0-0 Meloxicam2 x 1

Physical Examination (14/10/09)General StatusCM, ambulatory independent, gait N, right handedBody Weight : 55 Kg, Body height : 152 cm, BMI = 23,8 BP : 120/80 mmHg, HR : 80 x/minute, RR : 20 x/minuteHead and Neck: No Anemia, Icterus, Cyanosis, DyspneuThorax : Cor : S1S2 sound, murmur -, gallops - Pulmo : vesicular/vesicular, wheezing -/-, ronchi -/-Abdomen : Meteorismus - Liver / Spleen : unpalpable Extremities: warm acral +/+, edema -/-

Physiatric ExaminationMusculoskeletal examination

Cervical ROMMMTFlexionF (0-450)5ExtensionF (0-450)5Lateral FlexionF/F (0-450)5/5RotationF/F (0-600)5/5

TrunkROMMMTFlexionF (0-800)5ExtensionF (0-300)5Lateral FlexionF/F (0-350)5/5RotationF/F (0-450)5/5

ShoulderROMMMTFlexionActive 0-1400 /F (0-1800) 5-/5 Passive 0-1600ExtensionActive 0-400 /F (0-600) 5-/5Passive 0-500AbductionActive 0-1400/F (0-1800) 5-/5Passive 0-1500 AdductionActive F/F (0-450) 5/5Ext. Rot.Active 0-500/F (0-900)5-/5Passive 0-600Int. Rot.Active 0-600/F (0-700)5-/5Passive 0-700

ElbowROMMMTExtension-FlexionF/F (0-1500) 5/5 Forearm supinationF/F (0-800) 5/5 Forearm pronationF/F (0-800)5/5

WristROMMMTFlexionF/F (0-800)5/5ExtensionF/F (0-700)5/5 Radial deviationF/F (0-200)5/5 Ulnar deviationF/F (0-300)5/5 FingersROMMMTFlexion MCPF/F (0-900)5/5 PIPF/F (0-1000)5/5 DIPF/F (0-900)5/5ExtensionF/F (0-300)5/5AbductionF/F (0-200)5/5AdductionF/F (200-0)5/5ThumbROMMMTFlexion MCPF/F (0-900)5/5 IPF/F (0-800)5/5ExtensionF/F (0-300)5/5AbductionF/F (0-700)5/5AdductionF/F (500-0)5/5Opposition5/5HipROMMMTFlexionF/F (0-1200)5/5ExtensionF/F (0-300)5/5AbductionF/F (0-450)5/5AdductionF/F (0-200)5/5Ext. RotationF/F (0-450)5/5Int. RotationF/F (0-450)5/5KneeROMMMTExtension-FlexionF/F (0-1350)5/5 AnkleROMMMTPlantar FlexionF/F (0-500)5/5 Dorsi FlexionF/F (0-200)5/5 InversionF/F (0-350)5/5 EversionF/F (0-150)5/5 ToesROMMMTFlexion MTPF/F (0-300)5/5 IPF/F (0-500)5/5ExtensionF/F (0-800)5/5

Big ToeROMMMTFlexion MTPF/F (0-250)5/5 IPF/F (0-250)5/5ExtensionF/F (0-800)5/5Neurological Examination

N. Cranialis I XII : Peripheral N. VII palsy Physiological Reflex : BPR+2/+2 TPR+2/+2 KPR+2/+2 APR+2/+2Pathological Reflex : Babinski -/-, HT -/-Sensory deficit : - / -

Locally status Regio Shoulder D/S

I : Redness -/-Swelling -/- Deformity -/-P : spasme upper trapezius muscle +/+

Special Examination :

Compression: -/- Distraction: -/- TOS I, II, III: -/-, -/-, -/- Drop Arm Test: -/- Yergason Test: -/- Appley Scratch Test:- Abduction & External Rotation : F/Occipital- Adduction & Internal Rotation : F/VL V Laboratory studies Glucose fasting: 107 (13/10/09)X-ray right shoulder: (15/09/09)Foto tak tampak kelainan, osteoporotikDiagnosis : Frozen Shoulder Dextra

Functional diagnosis : Impairment: Stiffness Shoulder DextraDisability : Problem in ADL (wearing clothes)Handicap: Problem list :

1. Surgical : -2. Medical : Frozen Shoulder Dextra + DM + HT3. Rehabilitation Medicine: R1 (Ambulation) : - R2 (ADL):difficulty in wearing clothes R3 (Communication): - R4 (Sociological): - R5 (Psychological): - R6 (Vocational): - R7 (Others): - Pain in right shoulder (VAS=4) - ROM Limitation of right shoulder Planning :

1. Surgical : -2. Medical : continue the medication from Geriatric Department3. Rehabilitation Medicine :P. Dx : -P. Tx :a. Modality : USD Shoulder D frek 1 MHz, 2 W/cm2 for 10 minutesb. Gymnasium : Stretching right shoulder with :- Finger Ladder- Over Head Pulley

P. Mx : Clinical P. Ed : Health Education & Home Exercise Program - Towel Exercise- Wall Climbing Exercise- Active Pendular Glenohumeral Exercise- Post Pandrial ExerciseIt has been reported that a patient, 66 y.o. female, referred from Geriatric Out-patient Clinic with Osteoporotik Shoulder D. Chief complain was nyeri bahu kanan.Pain at right shoulder since 3 years ago. Pain such as dull pain. Pain felt especially after she washed clothes and when she moves her arm to the back to wear clothes. Pain was relieved when she take a rest. She still can cooking. Pain is not radiating. There are no numbness and tingling sensation.SummaryOn physical examination, there were limitation of ROM right shoulder and pain in shoulder movement. Limitation for right Appleys Scratch Test. Diagnose Frozen Shoulder Dextra. Planning Therapy are USD area right shoulder and stretching right shoulder with Finger Ladder and Over Head Pulley. Planning Monitoring are clinically and VAS. Planning Education for Health Education & Home Exercise Program are Towel Exercise, Wall Climbing Exercise, Active Pendular Glenohumeral Exercise and Post Pandrial Exercise.Planning Therapy are USD area right shoulder, stretching right shoulder, Finger ladder and Over Head Pulley. Planning Monitoring are clinically and VAS. Planning Education for Health Education & Home Exercise Program are Towel Exercise, Wall Climbing Exercise, Active Pendular Glenohumeral Exercise and Post Pandrial ExerciseThank you very much

Towel ExerciseActive Pendular Glenohumeral Exercise