frozen shoulder - adhesive capsulite 2012 dr. pink
DESCRIPTION
What is the Frozen Shoulder - Adhesive Capsulite and what a Physical Therapist can do for it , for you today. Cos'è la Capsulite Adesiva - Spalla Congelata e cosa può fare un Fisioterapista per questo problema, per te oggi. ITALIAN VERSIONTRANSCRIPT
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La “CAPSULITE ADESIVA” (o “Spalla Congelata”)
What we know today, what we can do
Dr. Riccardo Rosa FT, COMT
www.riccardorosa.it
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FROZEN SHOULDER – ADHESIVE CAPSULITIS
- CONDIZIONE COMUNE
- EZIOLOGIA ANCORA NON CHIARA
- INTERVENTI VARI, NESSUNO STANDARD DEFINITIVO
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CERTEZZE
- Sviluppo in 4 FASI
- DOLORE
- AROM e PROM limitati
- Storia naturale positiva
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DOLORE Aree comuni
www.riccardorosa.it
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CLASSIFICATION
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FASI PATOLOGICHE
I - FASE PRE-ADESIVA o FLORIDA
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FASI PATOLOGICHE
II - FASE di CONGELAMENTO
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FASI PATOLOGICHE
III - FASE CONGELATA
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FASI PATOLOGICHE
IV – FASE di DISGELO
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RIABILITAZIONE OGGI (2012)
- Nessun trattamento definitivo
- Vari Interventi studiati con outcomes positivi (Medicazioni via orale, Infiltrazioni di corticosteroidi, Esercizi, Mobilizzazioni
articolari, Distensioni capsulari, Agopuntura, Manipolazioni in anestesia, Blocchi nervosi, Chirurgia)
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TRINCEA CLINICA
• Body Chart + Anamnesi
• Ragionamento Clinico
• Esame Fisico (“rule out” red flags, colonna cervicale e sistema neurale)
• Scale di Valutazione (DASH, SST, Penn Shoulder Score, ASES, SPADI)
• Ipotesi Disfunzionale > OBIETTIVI Trattamento
• EBM + EBP
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MODELLO RIABILITATIVO di Kelley
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FASE PRE-ADESIVA o FLORIDA e FASE di CONGELAMENTO
Caratteristica chiave: ALTA IRRITABILITA’
Obiettivo Riabilitativo:RIDUZIONE DOLORE
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Cosa ha senso fare nelle Fasi I - II?
- Educazione del paziente (storia naturale della patologia e la positività della prognosi)
- Calore (SWD Short Wave Diathermy – Hot packs)
- TENS
- Infiltrazioni intra-articolari di corticosteroidi nelle prime 4 – 6 settimane (Buchbinder et al. 2003)
- NSAID
- Blocco neurale del sopra-scapolare (Harmon & Heary 2007)
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Cosa ha senso fare nelle Fasi I - II?- Trigger Point Therapy (Simons et al. 1999, Jankovich & van Zundert 2006)
- Stretching + Esercizi ROM bassa intensità – breve durata PAIN FREE
- Programma di esercizi a casa (HEP) PAIN FREE
- Terapia Manuale: mobilizzazioni articolari (movimenti accessori – artrocinematica) PAIN FREE
- Attività che diminuiscono il dolore per ridurre di conseguenza l’infiammazione (Hannafin & DiCarlo 1994, Marx et al. 2007)
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MYOFASCIAL TRIGGER POINTS Uno “spot” ipersensibile…• …all’interno di una banda tesa di un muscolo scheletrico…• …che è doloroso alla compressione, stretch, sovraccarico o
contrazione in posizione accorciata… • …che risponde con un DOLORE RIFERITO percepito spesso
lontano dallo spot (Simons et al 1999)• (inoltre: LTR, Jump Sign, Calore-Bruciore, Profondità)
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FASE CONGELATA
Caratteristica chiave:MODERATA IRRITABILITA’
Obiettivo Riabilitativo:RIDUZIONE della TERAPIA
ANTINFIAMMATORIA & ANTIDOLORIFICAINCREMENTO AROM - PROM
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Cosa ha senso fare nelle Fase III?
- Esercizi passivi di stretching (Griggs et al. 2000)
- Esercizi senza dolore, esercizi “pendolari”, HEP Home Exercise Program (Diercks RL et al. 2004)
- Mobilizzazioni EOR End of Range (Vermeulen et al. 2006)
- Positional stretching of coraco-humeral ligament (Ruiz 2009)
- Dynamic splinting (Gaspar & Willis 2009)
- Mobilizzazioni Scapolari + Stretching Capsulare Posteriore (İrem Duzgun et al. 2012)
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FASE di DISGELO
Caratteristica chiave:BASSA IRRITABILITA’
Obiettivo Riabilitativo:INCREMENTO AROM - PROM
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Cosa ha senso fare nelle Fase IV?
- Mobilizzazioni EOR End of Range (Diercks RL et al. 2004, Vermeulen et al 2009)
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