Farrell Kevin, Lampe Katherine
St Ambrose University, Davenport, IA, USA.
J Man Manip Ther. 2017 Feb;25(1):47-56. doi: 10.1179/2042618614Y.0000000092. Epub 2016 Feb 12.
Patients with adhesive capsulitis are commonly seen by physical therapists. Pain and limited shoulder motion from adhesive capsulitis have at times been linked to neural irritation. The purpose of this case is to describe the examination and intervention of a patient with adhesive capsulitis who appeared to have a coexisting, underlying neural irritation. This paper emphasizes how the neurological component must initially be identified and addressed for a successful outcome.
A 47-year-old female presented with reduced shoulder motion and function, upper extremity neural irritation, diffuse weakness, altered sensation in the involved extremity, and symptoms reproduced with upper limb neurodynamic testing. Her reduced shoulder range of motion was accompanied by limited glenohumeral glides and a report of local neck stiffness. Symptoms began several months earlier after an apparent electrical shock injury to the arm that caused symptoms and guarding of the shoulder. Intervention initially addressed the underlying neural component with spinal mobilizations while avoiding further irritation. Interventions were progressed to include mobilization and exercise to address shoulder mobility.
The patient's neurodynamic irritability, distal symptoms, and neck stiffness were normalized within the first weeks of care. Subsequently, interventions were directed at the shoulder. Outcomes over an 12-week time frame included reduced pain from 10/10 to 2/10. Passive range of motion increases included flexion from 121 to 160°, abduction from 71 to 121°, and external rotation from 18 to 60°. Disability scores on Disabilities of the Arm, Shoulder, and Hand (DASH) dropped from initially 68·3 to 18·3% at discharge. She ultimately regained full upper extremity function.
Therapists should be cognizant of possible neural irritation in shoulder disorders, which may contribute to conditions such as adhesive capsulitis. Identifying neural irritation is critical when determining which interventions will achieve optimal outcomes without aggravating the condition.
物理治疗师经常会接诊患有粘连性关节囊炎的患者。粘连性关节囊炎引起的疼痛和肩部活动受限有时与神经刺激有关。本病例的目的是描述一名患有粘连性关节囊炎且似乎并存潜在神经刺激的患者的检查和干预情况。本文强调了为取得成功结果，必须首先识别并处理神经学方面的问题。
一名47岁女性，出现肩部活动和功能减退、上肢神经刺激、弥漫性无力、患侧肢体感觉改变，以及上肢神经动力测试时症状再现。她的肩部活动范围减小，同时伴有盂肱关节滑动受限和颈部局部僵硬的报告。症状在数月前因手臂明显电击伤后开始出现，电击伤导致肩部症状和保护性反应。干预措施最初通过脊柱松动术处理潜在的神经问题，同时避免进一步刺激。随后进展到包括针对肩部活动度的松动术和锻炼。
在护理的最初几周内，患者的神经动力激惹、远端症状和颈部僵硬均恢复正常。随后，干预措施转向肩部。在12周的时间范围内，结果包括疼痛从10分降至2分。被动活动范围增加包括：前屈从121°增加到160°，外展从71°增加到121°，外旋从18°增加到60°。手臂、肩部和手部功能障碍（DASH）评分从最初的68.3%降至出院时的18.3%。她最终恢复了完全的上肢功能。
治疗师应认识到肩部疾病中可能存在的神经刺激，这可能导致粘连性关节囊炎等病症。在确定哪些干预措施能在不加重病情的情况下取得最佳效果时，识别神经刺激至关重要。
