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If it is true adhesive capsulate with fibrosis of the capsule, there's not much anyone (MD and PT) can do except to let it run its course over the avg of 28 months (I think that's the average course). Although, I understand that MD's are beginning to try brisement (inflating the capsule with air to stretch it). With a manipulation under anesthesia, it's the healthy tissue that tears, not the fibrotic tissue (for the most part). If it isn't adhesive cap, then before working overhead/elevation, the patient will first need 45 degrees or greater ER for clearance of the LHB from the coracoacromial arch. Jason ----- Original Message ----- From: "nabil keshavjee" <[log in to unmask]> To: <[log in to unmask]> Sent: Sunday, April 10, 2005 8:34 PM Subject: Re: Frozen Shoulder > Dr. Sood, > As for regaining normal ROM for shoulder dysfunction, > I rarely find extension limited, and if it is would be > the first to act upon as it is easiest to regain. At > the same time though I would work on flexion. Reason > being it seems to be the most functional. > I usually send pts. home with flexion exercise, but > when seeing them check and mobilise other ROM > directions. As some respond better than others to > mobilisations and PROM. If there is any other movt. > that responds favourable to treatment, I will once > again get them working on that movt. as well. > My last movt. is usually Hand Behind Back. > HOpe it helps. > > Nabil > --- "Dr.Sarveshwar Sood" <[log in to unmask]> wrote: > > Dear friends, > > We see, in this shoulder > > dysfunction ,loss of ROM in more then one direction > > ,in our effort to recover the lost ROM we use Mobs > > and exercises in addition to physiotherapy ,I wish > > to invite opinion of the house regarding preference > > of movements to recover and rationale behind it. .I > > have read that flexion ,then extension follower by > > medial rotation then lateral rotation and last > > glenohumral abduction ,one should work to regain ROM > > in this way ,instead of working in all the > > directions.Please tell us your experiences. > > > > Thanking you, > > > > DrSarveshwar Chander Sood > > > > Orthopaedic Surgeon & Head Department of Physical. > > S.B.L.S.Hospital > > 812/1,Housing Board Colony > > Model Town,Jalandhar city > > Punjab State.India > > E-mail [log in to unmask] > > "For all the happiness mankind can gain is not in > > pleasure....but relief from pain." > > > > > > > > ______________________________________________________________________ > Post your free ad now! http://personals.yahoo.ca > >