Shoulder function in patients with frozen shoulder syndrome the effect of conservative treatment and manipulation under general anaesthesia
Date
2012-11-16
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Abstract
Adhesiivne kapsuliit on laialt levinud liigeshaigus, mis põhjustab patsientidel probleeme igapäevaeluga hakkamasaamisel, halvendades nende elukvalieeti. Tuginedes läbitöötatud kirjandusele võib väita, et puudulikult on uuritud õlavöötme lihaste jõu ning vastupidavuse taastumist antud diagnoosiga patsientidel rehabilitatsiooni protsessis.
Käesoleva töö eesmärgiks oli välja selgitada õlaliigese ja õlavöötme lihaste funktsionaalse seisundi taastumise iseärasused konservatiivse ravi ning üldanesteesias teostatud redressiooni ja sellele järgnenud füsioteraapia mõjul. Uuringus osales 25 õlaliigese adhesiivse kapsuliidiga patsienti. Neist 10 patsienti said kuu aja jooksul konservatiivset ravi ja 15-l patsiendil teostati redressioon üldanesteesias, millele järgnes füsioteraapia. Patsientidel määrati enne ja pärast ravi õlavöötme lihaste isomeetrilise jõu, vastupidavuse ja staatilise töövõime ning õlaliigese liikuvuse näitajad. Samuti hinnati neil valu õlaliigese piirkonnas. Füsioteraapia koosnes õlaliigese liikuvust, õlavöötme lihaste jõudu ning vastupidavust parandavatest terapeutilistest harjutustest. Vajadusel kasutati massaaži õlavöötme lihaste pinge alandamiseks ning füüsikalist ravi valu leevendamiseks.
Töö tulemusena selgus, et õlavöötme lihaste isomeetriline jõud, vastupidavus ja õlaliigese liikuvus oli haigel jäsemel märgatavalt vähenenud nii enne konservatiivset ravi kui ka üldanesteesias teostatud redressiooni. Kuuajalise konservatiivse ravi tulemusena suurenes õlaliigese õlavöötme lihaste isomeetriline jõud ja staatiline töövõime ning õlaliigese liikuvus. Üldanesteesias teostatud redressiooni ja sellele järgnenud füsioteraapia järgselt nähtus, et õlavöötme lihaste isomeetrilise vastupidavuse taastumine oli aeglasem võrreldes lihaste isomeetrilise jõu ja õlaliigese aktiivse liikuvusega. Seejuures jäi õlavöötme lihaste isomeetriline vastupidavus ning õlaliigese liikuvus fleksioonil ja välisrotatsioonil alanenuks veel kuus kuud pärast redressiooni üldanesteesias.
Kokkuvõttes näitas uuring, et adhesiivse kapsuliidi puhul on füsioteraapias oluline pöörata senisest rohkem tähelepanu õlavöötme lihaste vastupidavuse taastamisele.
Frozen shoulder syndrome is a common shoulder condition which causes patients problems in everyday life and lowers their quality of life. As of our knowledge, the shoulder muscle isometric strength and endurance have not been the main reported parameters of the treatment outcome after treatment in patients with this diagnose. The main goal of the present study was to follow the improving shoulder joint and shoulder muscle functional outcome after conservative treatment and manipulation under general anaesthesia with followed physiotherapy. Twenty-five patients with frozen shoulder syndrome participated in this study. Ten of them received conservative treatment during one month, and fifteen of them received manipulation under general anaesthesia with followed physiotherapy. Muscle isometric strength, endurance, and static working capacity, also shoulder joint range of motion were measured before and after therapy. Patients were also screened against the shoulder pain. Physiotherapy consisted of therapeutic exercises for improving shoulder joint range of motion and shoulder muscle strength. In addition massage and electrical therapy was used for pain relief. Study results showed that patients with FSS were reduced shoulder muscle isometric strength, endurance, and shoulder range of motion for the involved extremity before conservative treatment and manipulation under general anaesthesia. One month of conservative treatment resulted with increased shoulder muscle isometric strength, and static working capacity, and shoulder range of motion. The recovery of shoulder muscle isometric endurance after manipulation under general anaesthesia was more delayed than the recovery of isometric strength and shoulder range of motion. However, shoulder range of motion during flexion and external rotation remained reduced for six months after manipulation under general anaesthesia. Conclusion rehabilitation process should prioritize shoulder muscles endurance recovery as this takes significantly more time compared with other characteristics.
Frozen shoulder syndrome is a common shoulder condition which causes patients problems in everyday life and lowers their quality of life. As of our knowledge, the shoulder muscle isometric strength and endurance have not been the main reported parameters of the treatment outcome after treatment in patients with this diagnose. The main goal of the present study was to follow the improving shoulder joint and shoulder muscle functional outcome after conservative treatment and manipulation under general anaesthesia with followed physiotherapy. Twenty-five patients with frozen shoulder syndrome participated in this study. Ten of them received conservative treatment during one month, and fifteen of them received manipulation under general anaesthesia with followed physiotherapy. Muscle isometric strength, endurance, and static working capacity, also shoulder joint range of motion were measured before and after therapy. Patients were also screened against the shoulder pain. Physiotherapy consisted of therapeutic exercises for improving shoulder joint range of motion and shoulder muscle strength. In addition massage and electrical therapy was used for pain relief. Study results showed that patients with FSS were reduced shoulder muscle isometric strength, endurance, and shoulder range of motion for the involved extremity before conservative treatment and manipulation under general anaesthesia. One month of conservative treatment resulted with increased shoulder muscle isometric strength, and static working capacity, and shoulder range of motion. The recovery of shoulder muscle isometric endurance after manipulation under general anaesthesia was more delayed than the recovery of isometric strength and shoulder range of motion. However, shoulder range of motion during flexion and external rotation remained reduced for six months after manipulation under general anaesthesia. Conclusion rehabilitation process should prioritize shoulder muscles endurance recovery as this takes significantly more time compared with other characteristics.
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Keywords
õlaliiges, konservatiivne ravi, lihasjõud, taastusravi, liigesehaigused, vastupidavus, conservative treatment, muscle strength, rehabilitation, joint diseases, endurance, õlaliiges, konservatiivne ravi, lihasjõud, taastusravi, liigesehaigused, vastupidavus, conservative treatment, muscle strength, rehabilitation, joint diseases, endurance