Treatment of Limited Shoulder Motion: A Case Study Based on Biomechanical Considerations

Abstract

This article describes the management of a 57-year-old female patient following a fracture and dislocation of the right humeral head. The treatment of the patient involved the use of thermal agents, manual therapy, continuous passive motion, and splinting of the arm in an elevated position. We describe an approach to treatment of limited shoulder motion that is focused on identifying and applying tension to restricting structures rather than restoration of translatory gliding movements of the humeral head. Our treatment approach is based on recent data from biomechanical studies that challenge the concave-convex theory of arthrokinematic motion first described by MacConaill. We believe that tension in capsular tissues, rather than joint surface geometry, may control the translatory movements of the humeral head. The rationale for treatment involving low-load prolonged stress to tissues in the form of continuous passive motion and splinting is discussed as well as potential limitations of more brief forms of stress such as joint mobilization and manual stretching.

Positional Stretching of the Coracohumeral Ligament on a Patient with Adhesive Capsulitis: A Case Report

“…The targeted intervention was aimed at providing a positional low load and prolonged stretch to the ChL and the area of the rotator interval capsule following anatomical fiber orientation. A favorable prognosis was anticipated from this intervention and was supported with the rationale of tissue remodeling through gentle and prolonged tensile stress on identified restricting tissues 5 .…”

“…Pain, particularly in the first phase of adhesive capsulitis, often keeps patients from performing activities of daily living 4 . Various treatment approaches have been described for limited shoulder passive range of motion (ROM) 5 . These approaches include different forms of manual therapy, electrotherapy, active exercise, and several forms of passive stretching 5 .…”

“…Various treatment approaches have been described for limited shoulder passive range of motion (ROM) 5 . These approaches include different forms of manual therapy, electrotherapy, active exercise, and several forms of passive stretching 5 . Previously published prospective studies of effective treatment approaches for gaining shoulder ROM in patients with frozen shoulder have demonstrated conflicting results 6 .…”

Glenohumeral Gliding Manipulation Following Interscalene Brachial Plexus Block in Patients With Adhesive Capsulitis

“…Betions increase range of motion in support of recent research addressing cause the posterior glide manipulafour directions (flexion, abduction, accessory joint glides that occur with tion procedure that was used internal rotation, and external rota-physiological glenohumeral move-emphasized stretching of the postetion)?" may be explained with the ments (16,19,28,38). rior capsule, we felt as if posterior adhesions may have caused the humeral head to be positioned in its most anterior excursion and, thus, limited both anterior and posterior glides.…”

The Effect of Anterior Versus Posterior Glide Joint Mobilization on External Rotation Range of Motion in Patients With Shoulder Adhesive Capsulitis

“…43 Thus, it is thought that the tension in the capsular tissues rather than joint surface geometry controls the translatory movements of the humeral head. 27,39 Asymmetrical capsular tightness has the potential to impact humeral head motion, especially when tension in the capsule increases as the arm is taken further into elevation. Ludewig and Cook 36 found that patients with shoulder symptoms showed greater anterior translation of the humeral head in 30° to 60° of scapular plane elevation of the humerus and a decrease in the mean posterior translation of the humeral head in higher elevations (60°-120°), as compared to an asymptomatic comparison group.…”