Chapter 6: Frozen Shoulder Management and Manual Treatment Strategies 2 CC Hours
By: Mark Albert M. Ed., PT, L.A.T., ATC, SCS Learning objectives
After completing this course, the learner will be able to: Define the pathophysiology of shoulder stiffness. Classify the Time-Phased Progression of Frozen Shoulder Dysfunction. List Determinants of Effective Shoulder Joint Mobilization. Course overview Shoulder dysfunctions causing painful stiffness are endemic is- sues, causing clinical challenges and conflicting treatment guide- lines. Common terminology of frozen shoulder and adhesive capsulitis share significant and long duration impairments. This advanced course reviews pathophysiology of these conditions, the natural history associated with idiopathic frozen shoulder and essential assessment findings. Based on updated scientific evidence, a review and compilation of available interventions of conservative, medical and invasive options is presented. The role of manual therapy methodology is Implicit bias in healthcare Implicit bias significantly affects how healthcare professionals perceive and make treatment decisions, ultimately resulting in disparities in health outcomes. These biases, often unconscious and unintentional, can shape behavior and produce differences in medical care along various lines, including race, ethnicity, gen- der identity, sexual orientation, age, and socioeconomic status. Healthcare disparities stemming from implicit bias can mani- fest in several ways. For example, a healthcare provider might unconsciously give less attention to a patient or make assump- tions about their medical needs based on race, gender, or age. The unconscious assumptions can lead to delayed or inadequate care, misdiagnoses, or inappropriate treatments, all of which can adversely impact health outcomes. Addressing implicit bias in
Review evidence-based Treatment Options. Develop a practical progression for mobilization. Create treatment Goals and Discharge Criteria for Shoulder Stiffness. Investigate Treatment Plateaus and Strategies. featured. Due to variability in patient progress and manual thera- py approaches, specific guidelines on type, timing, position and amplitude are investigated to standardize joint mobilization ef- forts. Finally, treatment program principles of patient education, suggested number of visits, daily clinical visit structure, manage- ment of plateaus and beneficial integration with medical/invasive procedures are discussed. The purpose of this course is to provide clinicians with an evidenced- based approach on treating frozen shoulder and associated conditions. healthcare is crucial for achieving equity in medical treatment. Strategies to combat these biases involve education and aware- ness programs for healthcare professionals. These programs help individuals recognize and acknowledge their biases, fostering a more empathetic and unbiased approach to patient care. Addi- tionally, implementing policies and procedures prioritizing equi- table treatment for all patients can play a pivotal role in reduc- ing healthcare disparities. Ultimately, confronting implicit bias in healthcare is essential to creating a more just and equitable healthcare system where everyone receives fair and equal treat- ment regardless of their background or characteristics.
INTRODUCTION
Despite advances in medical technology and research design, aspects of early assertions still apply to today’s management of frozen shoulders. Studies by early practitioners of orthopedic medicine emphasized manual techniques as primary treatment method for the resolution of frozen shoulder, particularly the idio- pathic type. Since these studies, an extensive level of additional research has investigated shoulder stiffness. A recent meta-analy- sis reviewed 5,411 studies in their meta-analysis of targeted inter- ventions (Zreik 2016). This course will define the terminology of frozen shoulder and related mobility limitations, list the variable etiologies and con- comitant dysfunctions, review the scope of the problem and iden- tify the time-phased spectrum of shoulder stiffness. Therapists will learn to understand treatment options using manual therapy principles and techniques and will present a practical sequence of guidelines aimed at restoring function.
The shoulder joint complex is a biomechanical system that func- tions on a delicate balance between mobility and stability. Mul- tiple activities of daily living, work tasks and recreational/ sports pursuits are dependent on mobility in multi-planar directions. The shoulder joint typically functions to elevate the position of the hands in space. For this discussion, the term elevation will include the cardinal planes of flexion and abduction and the essential in- termediate functional plane, called the plane of the scapula. The disorder labeled frozen shoulder was first described in the litera- ture as an indistinct condition with a longstanding dysfunction of up to two years, which posed a challenging treatment demand (Codman, 1934) Currently, the American Shoulder and Elbow Sur- geons defines it as: “Condition of uncertain etiology characterized by significant restriction of both active and passive shoulder motion that occurs in the absence of a known intrinsic shoulder disorder. ” (D’Orsi et., 2012, pg. 70) Frozen Shoulder (FS) is a condition in which insidious and sponta- neous anterior shoulder pain gradually worsens. This pain causes loss of active and passive mobility, and progressive limitations of common daily functions. Individuals with frozen shoulder tend to protect the shoulder from elevation motions which leads to them self-immobilizing the shoulder toward a sling position. Part of the conflicting nature of shoulder stiffness is the way scientif- ic literature uses several interchangeable terms such as; frozen
TERMINOLOGY AND INCIDENCE
shoulder, idiopathic shoulder stiffness, adhesive capsulitis, and ar - thro-fibrosis of the capsular-ligament-complex. Bunker (2009) has subsequently re-defined this group of dysfunctions with the term, contracted capsule, which encompasses the long-term treatment challenges. Multiple frozen shoulder and adhesive capsulitis studies show the societal prevalence is between 2%-5% (Pandey 2022; Kelley, 2009) and that number is projected to increase over the next sev-
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Book Code: PTCA2624
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