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  • Rotator Cuff Tendinopathy

    Rotator Cuff Tendinopathy

    It refers to the pain and weakness of rotator cuff musculature Rotator cuff comprises of four main muscles viz. Subscapularis, Supraspinatus, Infraspinatus, Teres Minor responsible for abduction and rotation movement of shoulder

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    EPIDEMIOLOGY

    Commonly affects athletes involved in sporting activities like Cricket, Swimming, Throwers etc and it can be age related problem affecting old aged patients their is an incidence of 11.2 cases per 1000 patients per year

    CLININCAL PRESENTATION AND PATHOPHYSIOLOGY

    Their is a difference between tendinitis and tendinopathy. Tendinitis is an inflammation of tendons whereas tendinopathy is deterioration of tendons. Rotator Cuff tendinopathy is clinically presented with

    Pain, Weakness, Loss of strength to bear load aur lift weight on shoulders along with tenderness around shoulder joint painfull overhead movement localised swelling may also be present

    MECHANISM

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    PHYSICAL EXAMINATION AND DIAGNOSIS

    For Physical examination two clinical tests are performed namely

    Empty can test and Hawkins test

    Other tests include Modified Belly press test, Palpation, ROM testing the latter two are not so significant In order to see how the tests are performed visit

    https://www.physio-pedia.com/Rotator_Cuff_Tendinopathy

    Other diagnostic tools include ultrasound, radiographs, radionucleotide isotope scan, magnetic resonance imaging (MRI), computed axial tomography (CT), electromyography

    Ultrasound reveal partial tear of tendon fibres partial thickened tears and thickened subacromial bursa MRI also reveals rotator cuff tears

    DIFFERENTIAL DIAGNOSIS

    Osteoarthritis

    Biceps tendinopathy

    Frozen Shoulder

    Cervical Disc Disease

    Cervical Spondylosis

    MEASUREMENT

    For measuring extent of rotator cuff tendinopathy VAS score, SPADI (Shoulder pain and disability index) have be adopted extensively by physiotherapist

    PHYSIOTHERAPY MANAGEMENT

    Physiotherapy is the gold standard treatment for rotator cuff tendinopathy along with Medical Management in majority cases and rarely require surgical intervention if Conservative treatment doesn’t work Medical Management includes NSAIDS, Shoulder immobilisation etc Surgery involves Arthroscopic intervention Physiotherapy treatment includes step wise procedure firstly Stretching, ROM exercises and then Muscle Strengthening exercises for pain management Ultrasound, TENS etc Modalities can be applied Kinesiotaping have shown better result in patients with Rotator Cuff Tendinopathy. Other techniques include

    Isometric exercises

    Kinetic Chain exercises

    Correcting scapulohumeral rhythm

    Corrective Posture

    Pilates technique

    for more info visit

    https://www.physio-pedia.com/Rotator_Cuff_Tendinopathy

  • Frozen Shoulder aka Adhesive Capsulitis

    also known as adhesive capsulitis basically is an inflammatory painful stiff condition of shoulder joint that develops gradually causing pain which can get worse at night and limits shoulder range of motion.

    EPIDEMIOLOGY

    It involves individual aging between 40-70 years with mean prevalence of 30% patients with diabetes with higher majority of prevalence among type-1 diabetes patients and lifetime prevalence of frozen shoulder is estimated around 2-5% among general population

    CLINICAL FEATURES AND PATHOPHYSIOLOGY

    Frozen shoulder can be Primary (Idiopathic) or Secondary (due to any underlying disease) It consists of 3 stages viz. 1. Painful stage 2. Freezing stage 3. Thawing stage Clinically presented with

    Pain, Loss of Range of motion, Stiffness

    Pain is not localised may radiate to biceps area and deep seated pain in nature it may be localised around anterior or posterior capsule.

    PHYSICAL EXAMINATION AND DIAGNOSIS

    Adhesive Capsulitis hallmarks loss of range of motion so examine Range of shoulder motion in all planes and movements viz flexion, extension, abduction, adduction, internal and external rotation

    For internal rotation its recommended to use Apley’s scratch test

    Palpation may reveal diffuse vague tenderness over anterior and posterior shoulder

    If loss of motion is observed therapist may apply scapular stabilization and assist movement for accurate testing

    Radiography is not that useful however can be performed to rule out other pathology MRI may reveal capsular thickening Basic diagnostic tool is physical examination ROM testing,Palpation etc

    Indexes included for measuring frozen shoulder pain and disability

    Shoulder Pain and Disability Index

    Disability of Shoulder and Hand

    Simple Shoulder test

    Penn Shoulder Scale

    VAS etc

    DIFFERENTIAL DIAGNOSIS

    Osteoarthritis Shoulder

    Rotator Cuff Pathology

    PTS syndrome

    Biceps tendinopathy

    Bursitis

    TREATMENT

    Medical management include use of corticosteroids, NSAIDS, Intracapsular Corticosteroid injection etc Surgical Management include Arthroscopic surgery, joint manipulation under anaesthesia to break adhesions but has moderate evidence to alleviate pain Physiotherapy is the cornerstone for frozen shoulder techniques include shoulder manipulation and mobilisation, ROM exercise, stretching techniques, Strengthening exercise, Modalities such as ultrasound, iontophoresis, cryotherapy, TENS are used to relieve pain. Physiotherapy along with Corticosteroid injection do miracles and help in long term relief

    For Stretching and Strengthening exercises for frozen shoulder visit

    https://www.health.harvard.edu/shoulders/stretching-exercises-frozen-shoulder

    For more info visit

    https://www.physio-pedia.com/Adhesive_Capsulitis

  • Lets Get Started

    Here we will cover entire syllabus and clinical approach with practical examples for aspiring and working physiotherapist

    The more you learn, the more you earn and more self confidence you will have

    Brian Tracy

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