Rehab OPD notes:

Frozen shoulder (adhesive capabilities)

It is a description of painful and stiff shoulder

Risk factors: idiopathic female cardiac disorder, DM, thyroid disorder

Patient can't perform active or passive movements

Loss of external rotation: pathognomonic sign , differentiates it from rotator cuff disorder

Capsule gets shrink : painful and restricted movements

There are 3 capsules in shoulder- anterior posterior and inferior

Diagnostic Test:

◽LAM- lateral rotation is more restricted to abduction and abduction is more restricted to medial
rotation

Ask pt to move :

◽Hand behind back

◽To touch the opposite shoulder

◽Hand behind neck

*nothing remarkable on x-ray, diagnosis is clinical

Treatment:

◽Capsular stretch

◽Strengthening exercises of shoulder

◽Theraband activity ( elastic band)

◽TENS

◽Joint mobilization

◽Wheel exercise to improve circumduction

◽Pulley

◽Finger ladder

◽Pendular activity

◽Soft tissue work

heat (chronic), cold( acute)

Cervical radiculopathy

pinched nerve
In upper cervical pathology symptoms are in head region

In lower cervical pathology symptoms in periphery

Pain radiates to shoulder as muscle weakness that travels down the arm into hand

Burning tingling numbness paresthesias

Diagnostic Test:

◽Spurling Test- if pain aggravates then the test is positive

Confirmatory test:

◽Distraction Test- if pain reliefs then the test is positive.

Physiotherapy Treatment:

◽TENS Transcutaneous electrical stimulation

◽Acute pain- cold therapy (cryotherapy)

Chronic pain- hot therapy

◽Soft tissue work

◽Neck muscle Strengthening exercises

◽Neurodynamics for relieving pain (nerve mobilization) median, radial and ulnar nerve mobilization

◽Spinal mobilization

•Traction

•Traction modality: - 30° flexion: in lower cervical pathology

- 30° extension: in upper cervical pathology

______________

ORTHOSIS- temporary

PROSTHESIS- permanent

AFO- Ankle foot orthosis used in foot drop _ foot planterflex , cannot dorsiflex ( for loosing tendon
& for contracting and realising muscles) & in stroke pts.

*Achilles Tendon can be tightened in foot drop

Dennis brown shoes DB shoes- used in club foot_ congenital tripalner deformity

Midfoot: C- cavus( high arched)

Forefoot: A – adducted

Hindfoot: V – varus

E – equinus ( planterflex)

CAVE mnemonic
Treatment:

Manipulation and casting by ponsetti method

After 7-8 attempts : if not corrected go for surgery

Incision : Turco incision and Cincinnati incision

In young kids first ponsetti then DB shoes

In older kids AFO

WHO (wrist hand orthosis)- used in wrist drop ( carpal tunnel/ website palsy)/stroke patients ( to
keep hand in position)

Management of wrist drop: splint( most important aim is to prevent contracture)

Medial arch / flat foot/ Pes planus:

Medial arch support is given in these pts

Pt can’t stand on one tiptoe on that leg

Dx by radiograph

By podometer

Risk factors : prolong standing, chronic use of high heels

Heel pads:

Heel pads given in heel spur / calcaneospur

(common in obese person, standing for long time, army, guards, females)

Dx by radiograph , by clinically

Once spur formed can’t be treated only pain can be relieved.

Spinal jacket / spinal orthosis:- indications: kyphosis ,scoliosis

Limits deformity and prevent it from being worsen.