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SpA su grupa bolesti u koje ubrajamo AS, ReA, PsA, SpA vezan za IBD, juvenilni SpA i nediferencirani oblik SpA. Bolesnici s nediferenciranim oblikom ne zadovoljavaju dijagnostičke kriterije drugih podtipova bolesti, barem ne u početku. S vremenom ovi bolesnici mogu razviti jedan od diferenciranih oblika. Genetski profil ovih bolesnika često uključuje prisustvo HLA- B*27 alela. Prema zadnjim ASAS klasifikacijskim kriterijima iz 2011.g za dijagnozu aksijalnog oblika SpA potrebno je prisustvo HLA-B*27 alela ili prisustvo sakroiliitisa. Sakroilitiis na RTG snimci smatra se definitivnim sakroiliitisom i tipičan je za uznapredovale oblike bolesti. Zbog velike inter- i intra-varijabilnost u interpretaciji RTG snimki, zahtjevi da se preispita uloga konvencionalne radiografije u dijagnosticiranju sakroiliitisa sve su češći. Pojavom učinkovitih terapijskih opcija pojavila se potreba za ranim i točnim dijagnosticiranjem ovih bolesti te je u kriterije uveden edem koštane srži SI zglobova na MR snimci (ne-radiografski sakroiliitis) koji je tipičan za rani oblik bolesti. Razvijanjem ovih kriterija postalo je moguće dijagnosticirati axSpA na vrijeme 80 te ranije započeti s liječenjem. Kod bolesnika s perifernim oblikom bolesti kliničkom slikom dominira artritis perifernih zglobova, entezitisi ili daktilitisi. Osim za HLA-B*27 alel, do sada ni jedna studija nije uspila snažno dokazati povezanost nonB*27 gena sa SpA. Ipak, neke studije sugerirale su moguću povezanost HLA-B*08, HLAB*38, HLA-B*39 i HLA-C*0602 sa PsA. S druge strane povezanost HLA-B*35 alela i SpA, bilo aksijalnim bilo perifernim oblikom bolesti, dugo je poznata no u nijednoj studiji sakroiliitis nije potvrđen MR-om niti su periferne manifestacije bolesti evaluirane UZV-om. Da bi istražili moguću povezanost sakroiliitisa viđenog na MR snimci i HLA-B*35 alela svim ispitanicima s dijagnozom nediferenciranog SpA uradili smo HLA tipizaciju i MR SI zglobova. Ispitanicima s kliničkom slikom nediferenciranog HLA-B*35 pozitivnog SpA i perifernim manifestacijama bolesti, UZV-om smo evaluirali zglobove i tetive. Naše istraživanje je pokazalo da je HLA-B*35 alel potencijalni rizični čimbenik za razvoj sakroiliitisa i sinovitisa perifernih zglobova kod bolesnika s kliničkom slikom nediferenciranog axSpa. Vjerujemo da prisustvo HLA-B*35 alela opravdava ranu implementaciju MR-a u detekciji sakroiliitisa i UZV-a u detekciji perifernih manifestacija kod HLA-B*35 pozitivnih bolesnika s preliminarnom dijagnozom nediferenciranog SpA s ciljem ranog prepoznavanja ovih bolesti i ranog uvođenje terapijskih modaliteta, Osim u pravovremenom postavljenju dijagnoze i uvođenju terapije, prisustvo HLA-B*35 alela može nam pomoći u ciljanom izboru vrste lijeka. Ovakav pristup može spriječiti razvoj oštećenja zglobova, nesposobnosti i invaliditeta te podići kvalitetu života u ovih bolesnika, SpA is a group of diseases which comprises AS, ReA, PsA, entheropathic arthritis, juvenile Spa and undifferentiated form of SpA. The genetic profile includes HLA- B*27 gene. Except for HLA-B*27, so far no study has been able to strongly prove the association of the nonB*27 gene with SpA. According to the ASAS classification criteria, the presence of HLAB*27 or the presence of sacroiliitis is required for the diagnosis of the axial form of SpA. The association between HLA-B*35 and SpA has long been known, but in no study has sacroiliitis been confirmed by MRI, nor have peripheral manifestations of the disease been evaluated by ultrasound. To investigate the possible association of sacroiliitis seen on MRI imaging and the HLAB*35, we have performed MRI of the SI joints and evaluated peripheral manifestations of the disease by ultrasound. Our study has showed that the HLA-B*35 is a potential risk factor for the development of sacroiliitis and synovitis of peripheral joints. We believe that the presence of the HLA-B*35 allele justifies the early implementation of MRI in the detection of sacroiliitis and ultrasound in the detection of peripheral manifestations in HLA-B*35 positive patients with preliminary diagnosis of undifferentiated SpA.

Although Croatia is a small country on the Mediterranean Sea, it has a hundredyear-old tradition in rehabilitation medicine. First rehabilitation facilities in Croatia were thermal resorts, which were the foundation for development of a large number of specialized rehabilitation centers. Also, in 1947, Croatian Society of Physical Medicine, Rehabilitation, Rheumatology and Balneology was founded, in 1967, Croatian Society for Rheumatology spun off as an independent society and since 2005 the society operates under the name Croatian Society of Physical and Rehabilitation Medicine. Since then, Society directs development of physical and rehabilitation medicine in our country. Materials and methods: Critical collection and study of data on present state of physical and rehabilitation medicine in Croatia. Results: At the moment, there are 1900 rehabilitation beds in Croatia, which is a high ratio of 0.42 per 1000 inhabitant, considering that the minimum recommended standard is 0.10. Croatia has the second highest ratio of physical and rehabilitation medicine (PRM) specialists per 100000 inhabitants among European Union of Medical Specialists (UEMS) member countries. Croatian Society of PRM, under current presidency of Prof. Tonko Vlak has steady membership of approximately 250 members and Board of 13, including one vice president, treasurer and secretary. We have included Board members from all Croatian regions, to keep the link with local PRM communities. Communications to members are done by regular e mails and through our web site www.hdfrm.com. CSPRM has regular meetings with lectures, the general assembly is held every year, elections every fourth year, as well as national congress. CSPRM owns and published its journal Fizikalna i Rehabilitacijska medicina since 1984. CSPRM is an active member to European Society of PRM. Croatian Medical Association was accepted in UEMS in 1996 and in 1997 our representative joined UEMS PRM Section and Board. Conclusions: Although some of these numbers are impressive, rehabilitation medicine in Croatia did not yet reach necessary standards. Rehabilitation medicine in Croatia needs to address many issues, such as increasing rehabilitation needs, abundance of PRM specialists and rehabilitation beds, as well as shortcomings in education, which is focused on rheumatology rather than rehabilitation. The existing traditional system of rehabilitation care can not satisfy the new standards set for quality and eficiency of rehabilitation medicine. Need for a change in Croatian educational and rehabilitation system was evident. Key words: physical medicine, rehabilitation, Croatia

Background: Psoriatic arthritis (PsA) can be associated with severe joint symptoms and with significant pain and stiffness, leading to chronic disability in performing activities of daily life. The correlation between SF 36 physical health and measures of disease activity has not been investigated. Objectives: To correlate SF-36 physical health (included general health) with measures of disease activity in PsA. Methods: One- hundred forty three consecutive adult patients of both genders (72 men, 71 women) with established diagnosis of PsA were enrolled in the study. Mean age was 57.75 10.91 years, the duration of PsA was 139.64 108.11 months and 35.7% of patients have never used DMARDs. SF-36 physical health included: physical functioning (PF), role limitations physical (RP), bodily pain (BP), and general health (GH). Disease activity was assessed using the following variables: tender joint count (TJC) (68 joints), swollen joint count (SJC) (66 joints), patient's global assessment (PtGA) (on VAS), examiner's global assessment (EGA) (on VAS), ESR (mm/hour) and CRP (mg/dl). Apart from descriptive statistics, Spearman's coefficient was used in order to investigate the correlations. Results were adjusted according to gender, age, and to the duration of PsA. The significance was set up at p=0.05. Results: The results for SF-36 were: PF 42.61±24.08, RP 19.66±32.23, BP 34.78±23.35 and GH 33.12±16.18. Significant correlations were found for SF-36 PF with TJC, SJC, PtGA, EGA and DAS, for SF-36 RP with TJC, and EGA, for SF-36 BP with TJC, PtGA, EGA, and DAS and for SF-36 GH with TJC, PtGA, and EGA. After adjustment, all correlations for SF-36 PF and SF- 36 BP were preserved. For SF-36 RP the result remained significant for PtGA, with the additional correlation with DAS, while for SF- 36 GH it retained significance only with TJC and PtGA Conclusions: In this cross-sectional study of patients with PsA correlations were found between SF-36 physical health domains and several parameters of disease activity, those of TJC and EGA seem being the most consistent ones.

Results of a multicentric study on arterial hypertension in patients with rheumatoid arthritis and osteoarthritis in Croatia are presented.

Ishemijska bolest srca jedna je od vodećih uzroka smrti u svijetu. Na nastanak ishemijske bolesti srca utječu mnogi čimbenici rizika kao što su pušenje, nezdrava prehrana, visoka razina stresa te nedostatak tjelesne aktivnosti. Iako se liječenje značajno poboljšalo organizacijom mreže primarne perkutane intervencije za zbrinjavanje akutnog infarkta miokarda, značajan broj bolesnika i dalje umire. Komplikacije infarkta miokarda i reinfarkcije su česte, a pravilnom kardiološkom rehabilitacijom i prevencijom njihova učestalost se može smanjiti. Fizioterapija kardioloških bolesnika zahtijeva interdisciplinarni timski pristup bolesnicima s funkcionalnim oštećenjima kao posljedice bolesti srca. Kardiološka rehabilitacija se provodi u tri faze. Prva faza uključuje razdoblje bolesnikovog boravka u bolnici za vrijeme akutne faze bolesti. Druga faza se provodi u poliklinici ili u specijalnoj bolnici za kardiološku rehabilitaciju, a treća faza je doživotna i uključuje vrijeme kada se pacijent vraća aktivnostima svakodnevnog života i nije vezana uz zdravstvenu ustanovu. Prije započinjanja rehabilitacije potrebno je postaviti ciljeve rehabilitacije te prema njima definirati terapijski plan. Kod sastavljanja terapijskog plana fizioterapeuti nailaze na problem određivanja intenziteta vježbanja. Međutim, kroz fizioterapijsku procjenu fizioterapeut uzima anamnezu, procjenjuje razinu aerobnog kapaciteta i mišićnu snagu bolesnika primjerenim i specifičnim testovima te prema tome određuje vježbe koje će pacijent koristiti. Osim rehabilitacije, fizioterapeut treba educirati bolesnika o čimbenicima rizika, te motivirati i poticati da nakon završetka rehabilitacije nastavi primjenjivati naučeno kroz cijeli život. Ischemic heart disease is one of the leading causes of death in the world. The occurrence of ischemic heart disease is influenced by many risk factors, such as smoking, unhealthy diet, high levels of stress and lack of physical activity. Although treatment has significantly improved with the organization of a network of primary percutaneous intervention for management of acute myocardial infarction, a significant number of patients still die. Complications of myocardial infarction and reinfarction are common, but with proper cardiac rehabilitation and prevention, their frequency can be reduced. Physiotherapy of cardiac patients requires an interdisciplinary team approach to patients with functional impairments as a result of heart disease. Cardiac rehabilitation is carried out in three phases. The first phase includes the period of the patient's stay in the hospital during the acute phase of the disease. The second phase is carried out in a polyclinic or in a special hospital for cardiac rehabilitation. The third phase is lifelong and includes time when the patient returns to the activities of daily living and is not connected to a health facility. Before starting rehabilitation, it is necessary to set rehabilitation goals and define a therapeutic plan. While creating a therapeutic plan, physiotherapists encounter the problem of determining the intensity of exercise. However, through the physiotherapy assessment, the physiotherapist takes medical history, assesses the level of aerobic capacity and muscle strength of the patient with appropriate and specific tests, and according to them determines the exercises that the patient will use. In addition to rehabilitation, the physiotherapist should educate patients about risk factors, motivate and encourage them to continue with what they have learned throughout rehabilitation in their lives after rehabilitation.

Laserska terapija visokog intenziteta je jedinstvena u svojoj sposobnosti da isporuči ljekovitu svjetlosnu energiju stanicama tijela prodirući kroz kosti, meko tkivo i mišiće. HILT može smanjiti bol, smanjiti natečenost, omekšati ožiljkasto tkivo i resetirati kronični ciklus boli.HILT je zabilježio 94% uspješnosti u poboljšanju funkcije i značajnom smanjenju simptoma. U ovom radu pronaći ćete dokaze o djelotvornosti i sigurnosti HILT terapije. Putem pretrage baze podataka, kao što su Medline, PubMed, EMBASE, Cochrane, Google Scholar i druge pronašli smo znanstvene literature koje upravo dokazuju tu djelotvornost i sigurnost pri liječenju mišićno koštane boli, a pretraživane su u razdoblju do kolovoza 2018. godine. U većini studija vidi se iznimno poboljšanje stanja pacijenata koji su se koristili HILT terapijom. Isto to poboljšanje nije samo djelotvorno nakon terapije već traje i do 3 mjeseca nakon. Tako osobe s navedenim poteškoćama mogu lakše funkcionirati u aktivnostima svakodnevnog života. High-intensity laser therapy is unique in its ability to deliver healing light energy to the cells of the body by penetrating through bones, soft tissue and muscles. HILT can reduce pain, reduce swelling, soften scar tissue, and reset a chronic pain cycle. HILT has recorded a 94% success rate in improving function and significantly reducing symptoms. In this paper, you will find evidence of the efficacy and safety of HILT therapy. By searching a database such as Medline, PubMed, EMBASE, Cochrane, Google Scholar and others, we found scientific literature that proves this efficacy and safety in the treatment of musculoskeletal pain, and were searched in the period up to August 2018. Most studies show remarkable improvement in the condition of patients using HILT therapy. The same improvement is not only effective after therapy but lasts up to 3 months after. That way, people with these difficulties can function more easily in the activities of everyday life.

Cerebralna paraliza je klinički entitet koji karakterizira poremećaj pokreta i položaja uzrokovan neprogresivnim oštećenjem nezrelog mozga. Mnogo je etioloških faktora zbog kojih dolazi do oštećenja mozga koje može uzrokovati cerebralnu paralizu. Posljedice oštećenja utječu na motoričku funkciju te mišićno-koštani i kognitivni razvoj, a javlja se i niz drugih pridruženih zdravstvenih poteškoća. Kada se govori o cerebralnoj paralizi uvijek treba naglasiti da cerebralna paraliza predstavlja ne samo medicinski problem, nego i psihološki i socijalni problem. Dijagnoza se postavlja kod djece kod koje je uočen usporeni razvoj motorike, koji se potvrđuje nalazima magnetske rezonancije. Terapija djeteta sa cerebralnom paralizom usmjerena je na ostvarivanje zadanog cilja. Dva glavna cilja su smanjiti komplikacije uzrokovane cerebralnom paralizom i poboljšati sposobnost usvajanja novih vještina. Dodatni ciljevi su edukacija roditelja, smanjenje tjelesnih deformacija i poboljšanje pokretljivosti. Cerebralna paraliza zahtijeva interdisciplinarni pristup te ima velik utjecaj i na dijete i na čitavu obitelj i život njenih članova. Svaki terapijski pristup bazira se na individualnom pristupu. Vrlo je bitno terapiju započeti što ranije jer ranija terapija olakšava razvoj djeteta i pridonosi boljem ishodu terapije i kvaliteti života. Terapija cerebralne paralize ne treba biti usmjerena samo na motoričke tretmane, već i na tretmane i drugih poremećaja od kojih dijete pati. Rijetko se kad terapija oslanja na samo jedan, a najčešće se primjenjuje kombinacija terapijskih postupaka. Takav pristup omogućava fleksibilnost i individualizaciju, kako bi se ostvarili ciljevi postavljeni za dijete i obitelj. Cerebral palsy is a clinical entity characterized by disorder of movement and posture caused by a non-progressive injury to the immature brain. There are many etiological factors that may cause brain injury that result in cerebral palsy. The consequences of brain injury may have an effect on motor function, musculoskeletal and cognitive development as well as on a range of other associated health issues. Also, when it comes to cerebral palsy, it should always be noted that it is not merely about a medical problem, but also the psychological and social components have to be taken into account. Diagnosis is made in children with slow motor development and is comfimed with findings from magnetic resonance imaging. In children with cerebral palsy, the treatment is aimed at achieving two main goals: reduce complications of cerebral palsy and improve the ability to acquire new skills. Additional goals are represented by parent education, reduction of body deformations and mobility improvement. Cerebral palsy has a major impact on the child, the whole family and their life, thus an interdisciplinary approach is required. It is important to begin the therapy as early as possible in order to facilitate the patient’s development and contribute to a better treatment outcome in terms of quality of life. Cerebral palsy treatment should not be focused only on improvement of motor skills; attention should be pointed at every kind of impairment from which the child suffers. In this view, a wide range of therapeutic approaches is available and a combination of therapeutic procedures is usually employed. This multimodal approach allows flexibility and treatment individualization toward achievement of specific goals set for the child and family.

Cilj rada. Prikazati uspješnost djelovanje fizioterapijskih postupaka u rehabilitaciji pacijenata sa sindromom bolnog vrata. Metode. Tijekom ispitivanja sam koristila goniometar, centimetarsku traku i VAS-skalu boli koje nam služe za procjenu funkcijskog stanja vratne kralježnice. Rasprava. Na temelju rezultata, koje sam dobila ispitivanjem koje je provedeno prvi i zadnji dan terapije, možemo dokazati uspješnost djelovanja precizno odabranih postupaka fizikalne terapije u liječenju sindroma bolnog vrata. Zaključak. Provedenim ispitivanjem je dokazano da fizikalna terapija uspješno djeluje na smanjenje boli i simptoma, poboljšanje pokretljivosti vratne kralježnice i kvalitetu života. Objective. To demonstrate the successs of physiotherapeutic procedures in the rehabilitation of patients with the painful neck syndrome. Methods. During the examination, I used a goniometar, a centimeter band and a VAS-scale of pain which help us to evaluate the cervical spine function. Discussion. Based on the results obtained by the first and last day of therapy, we can demonstrate the success of the highly selected procedures of physical therapy in the treatment of painful neck syndrome. Conclusion. The study has proved that physical therapy has been successful in reducing pain and symptoms, improving the mobility of cervical spine and quality of life.

Cilj. Prikazati najvažnije fizioterapijske postupke u rehabilitaciji bolesnika sa opeklinama šake. Pokazati utjecaj i uspješnost fizikalnih postupaka kroz vrijeme rehabilitacije. Pratiti psihofizički napredak od početka do kraja terapije. Cilj je omogućiti bolesniku maksimalni oporavak funkcije šake i potpuni povratak u zajednicu. Metode. Ovdje sam u najjednostavnijim crtama opisao načine izvođenja testova i mjerenja kod goniometrije i manualnog mišićnog testa. Prilikom procjene šake bitno je više puta ponavljati mjerenja radi mogućih pogrešaka i subjektivnosti testova. Rasprava. Postavio sam se na način da pacijent ne mora u potpunosti biti zadovoljan rehabilitacijom iako smo mi napravili sve što smo mogli i objektivno sve ciljeve ostvarili. Zaključci. Fizioterapijskim postupcima kod rehabilitacije šake omogućujemo bolesniku život u skladu s veličnom ozljede i trenutnim mogućnostima. Vraćanje bolesnika u stanje funkcionalnosti kao prije ozljede mu daje osjećaj korisnosti i podiže mu samopouzdanje. Dolazi do neovisnosti u svakodnevnom funkcioniranju i porastu samopoštovanja Objective. I want to show the most important physiotherapeutic procedures in hand rehabilitation in patients with burn injuries. To show the impact and the success of physical procedures over the course of the rehabilitation. The goal is to enable the patient his maximal functional recovery of the hand and his full return to the community. Methods. Here, I have in the simplest lines described the ways of doing tests and measurements in goniometry and manual muscle testing. During the assessment of a hand, it is significant to repeat the measurements number of times, due to the many possible errors that can occur while measuring and due to the subjectivness of the test. Discussion. I have put myself in a way that the patients doesn’t have to be satisfied with the outcome of the rehabilitation, even though we did all we could and accomplished all the goals respectively. Conclusion. With the physiotherapeutic procedures in rehabilitation of a hand we enable the patient the life according to the size of the injury and his abilities. The return of a patient to the previous state of functionality before the injury gives him the feeling of usefulness and builds his self-esteem. Independence will come in everyday life and an increase of self-respect.

Cilj. Cilj ovog rada je pokazati razne metode kojima možemo pomoći pacijentima koji pate od medijalnog epikondilitisa, kao i rehabilitaciju i edukaciju takvih pacijenata. Cilj rehabilitacije je naravno, povratak prijašnjim aktivnostima, a cilj edukacije prevencija. Metode. Goniometrija i manualni mišićni test su metode kojima radimo procjenu ovakvih pacijenata te pratimo njihov napredak kroz rehabilitaciju jer one diktiraju u kojem smjeru će ići rehabilitacija. Rasprava. Naveo sam mnogo metoda kako dijagnostičkih, tako i metoda liječenje. Svaka od njih ima svoje prednosti i mane, međutim one se trebaju birati s obzirom na pacijentovo stanje i mogućnosti. Zaključci. Sama rehabilitacija je dugotrajan proces te kako bi on bio što uspješniji trebamo pratiti pacijenta kroz svaki korak rehabilitacije uzimajući u obzir trenutno stanje pacijenta Objective. The goal of this paper is to show different methods we can use to help patients suffering with medial epicondylitis, as well as to show the rehabilitation process and education of the patient. The goal of rehabilitation is, of course, return to previous activities, the goal of education is prevention. Methods. Goniometry and manual muscle testing are methods we use to assess the current state of these patients so we can follow their progress through the rehabilitation process because those assessments dictate the path of the rehabilitation. Discussion. I have mentioned many methods be it diagnostic or treatment methods. Each of them has its pros and cons, but they need to be chosen accordingly to the patient’s present state. Conclusion. Rehabilitation alone is a long while process which, if it is to be successful, needs to be carefully followed trough, having in mind the patients present state.

Cilj rada. Prikazati sustavan rehabilitacijski protokol fizioterapijskih postupaka na zglobu šake kod osoba oboljelih od reumatoidnog artritisa. Ukazati na individualiziranost prilagodbe rehabilitacije na bolesniku u pojedinoj fazi bolesti. Cilj je da se istaknu pozitivni učinci koje možemo rehabilitacijom postići pojedinim postupkom u odnosu na početno stanje prije rehabilitacije. Metode. Funkcionalnim metodama mjerenja želio sam prikazati načine prikupljanja podataka koje služe za plan i procjenu napretka rehabilitacije. Istaknuo sam način uporabe HAQ i DAS-28 te njihovu važnost u procjeni funkcije šake. Rasprava. U ovom poglavlju sam naveo da je tijek reumatoidnog artritisa kroničan te vodi do destrukcije zglobova. Tom činjenicom sam želio istaknuti da se rehabilitacijskim protokolima iz ovoga rada ne može izliječiti bolest, već se mogu odgovarajućom terapijom smanjiti njene tegobe. Zaključci. Znanstvenim istraživanjem je u potpunosti opravdan rehabilitacijski protokol naveden u ovom radu, zato što su se funkcionalni deficiti pacijenta značajno poboljšali. Objective. To present a systematic rehabilitation protocol on physiotherapy procedures on the hand with patients suffering from rheumatoid arthritis. To show the individual adjustment of rehabilitation in a specific state of the disease. The objective is to point out the positive effects that we can achive with a procedure compared with the initial state. Methods. With functional methods of measurment I wanted to point out the ways to gather patients information which is used to plan and evaluate progress of rehabilitation. I showed how we can use HAQ and DAS-28 and their value in measuring hand functional capacity. Discussion. In this chapter I stated that progress of reumathoid arthritis is cronic and it leads to joint destruction. Due to that fact I stated that this disease can not be cured,but can only be treated by the right therapy aproach. Conclusion. This way of rehabilitation is aproved by scientific reasearch, bacause it has shown that the patients state has improved significantly.

Uvod: Charcot Marie Tooth neuropatija je najčešća nasljedna neurološka bolest. Spada u skupinu hereditarnih senzomotoričkih neuropatija. Uzrok bolesti je mutacija gena koja uzrokuje demijelinizaciju perifernih živaca , degeneraciju aksona ili oboje, pa se prema tome i dijeli na nekoliko genetskih različitih tipova, sličnih simptoma. Bolest se manifestira u prvim desteljećima života, a glavni simptomi su: mišićna slabost i hipotrofija distalnih mišića udova, poremećaj osjeta, nedostatak miotatskih refleksa, pes cavus. Ova bolest se liječi lijekovima za bol, pacijenti su doživotno uključeni u proces rehabilitacije i po potrebi se vrše kirurški zahvati deformiranih zglobova. Cilj rada: Istražiti dostupnu literaturu i prikazati sve fizioterapijske postupke koji se koriste u rehabilitacijskom tretmanu pacijenata oboljelih od Charcot Marite Tooth neuropatije. Rezultat: Fizioterapijski postupci koji se provode u rehabilitaciji pacijenata oboljelih od Charcot Marie Tooth neuropatije su: fizioterapijska procjena, postavljanje ciljeva fizioterapije, elektroprocedure, kineziterapija, hidroterapija, radna terapija, primjena ortopedskih pomagala i ostali. U elektroterapiji provodi se galvanizacija i elektrostimulacija. Kineziterapija je najvažnija grana fizioterapije u ovoj rehabilitaciji i cilj joj je održavanje funkcije lokomotornog sustava koristeći se aktivnim i pasivnim vježbama za snaženje mišića i povećanje opsega pokreta, vježbama propriocepcije i metodom biofeedback treninga. Hidroterapija je podrška kineziterapiji. Radna terapija provodi se u svrhu integracije pacijenta u okolinu. Važan aspekt ortopedskog liječenja za ove pacijente, u kojem sudjeluju fizioterapeuti, je primjena ortoza. Ostale procedure koje se koriste su: magnetoterapija, dijadinamske struje i termoterapija. Zaključak: Literatura je vrlo siromašna informacijama o ovoj bolesti, osobito o procesu rehabilitacije. Fizikalna terapija je najvažniji dio liječenja Charcot Marie Tooth bolesti, najvrijedniji njezin dio je kineziterapija za koju imamo i znanstvene dokaze o učinkovitosti. Introduction: Charcot Marie Tooth neuropathy is the most common inherited neurological disease. It belongs to a group of hereditary sensor-motor neuropathies. The cause of the disease is a mutation in the gene that causes demyelination of peripheral nerves, axonal degeneration, or both, and is therefore divided into a number of different genetic types with similar symptoms. The disease manifests itself in the first decades of life, and the main symptoms are: muscle weakness and muscle weakness and weakness of the distal muscles of the limbs, disturbance of sensation, lack of myotatic reflexes, pes cavus. This disease is treated with medication for pain, patients have a lifetime involved in the rehabilitation process and, if necessary, to carry out surgical procedures for deformed joints. Objective: To explore the available literature and display all physiotherapy procedures used in rehabilitation treatment of patients with Charcot Marite Tooth neuropathy. Result: The physiotherapy procedures to be applied in the rehabilitation of patients with Charcot Marie Tooth neuropathy are: physiotherapeutic assessment, goal setting physiotherapy, electroprocedures, kinesiotherapy, hydrotherapy, occupational therapy, the use of orthopedic devices and others. In electrotherapy galvanization and electro-stimulation. Kinesiotherapy is the most important branch of physiotherapy in the rehabilitation and aims to maintain the function of the musculoskeletal system using active and passive exercises to strengthen muscles and increase range of motion, proprioceptive exercises and biofeedback training method. Hydrotherapy support kinesitherapy. Occupational therapy is carried out to integrate the patient into the environment. An important aspect of orthopedic treatment for these patients, involving physiotherapists, the application of orthotics. Other procedures used are: magnetic therapy, diadynamic current and thermotherapy. Conclusion: The literature provides very poor information about the disease, especially the process of rehabilitation. Physical therapy is the most important part of the treatment of Charcot Marie Tooth disease, the most valuable part of it is kinesiotherapy for which we have scientific evidence of effectiveness.

Periferni ţivĉani sustav, kojeg ĉine svi ţivci izvan središnjeg, je odgovoran za prijenos ţivĉanih impulsa od mozga do mišića, organa, ţlijezda i ţila, te za prijenos impulsa u mozak iz osjetnih receptora raznih dijelova tijela te osjetnih organa. Oštećenje ţivca ovog sustava rezultira ispadom njegovog inervacijskog podruĉja. Najĉešće lezije perifernih ţivaca su : oštećenje nervusa facialisa, nervusa medianusa, nervusa peroneusa, nervusa ulnarisa te nervusa radialisa. Od posebne je vaţnosti n.radialis, ĉijom povredom najĉešće dolazi do stanja poznatim pod nazivom viseća šaka, koju karakterizira oteţana ili onemogućena ekstenzija šake i prstiju. Nervus radialis je mješoviti ţivac, što znaĉi da njegovom povredom nije oštećena samo funkcija šake, već i senzorika. MeĊutim, senzorni simptomi su minimalni te su ograniĉeni na malo podruĉje dorzuma šake. Do kompresije ţivca najĉešće dolazi na mjestu gdje on obilazi humerus, na sredini nadlaktice. Ĉesto do takve kompresije dolazi kod alkoholiĉara, koji se ujutro bude bez mogućnosti ekstenzije u šaci i prstima (paraliza subotnje veĉeri). RjeĊe mjesto kompresije se dogaĊa u visini supinatora, to je tzv. supinatorski sindrom, kod kojeg su, osim tipiĉnog motoriĉkog deficita, ĉeste i bolne senzacije koje iradiraju u prste. Dijagnoza ovog stanja je relativno lagana, postoji niz testova koji mogu ukazati na slabost motorike uobiĉajene za ovaj ţivac, a potvrĊuje se EMNG nalazom denervacije. Oporavak je izrazito dobar, fizikalna terapija ima bitnu ulogu u rehabilitaciji ove ozljede. Na primarnom mjestu se nalazi kinezioterapija, a dosta se obilno koriste i procedure elektrostimulacije te elektroterapije. Kinezioterapija obuhvaća pasivne, aktivno potpomognute te aktivne vjeţbe ( s otporom i bez). Kao uvodna procedura, za smanjivanje boli i povećanje mišićne kontrakcije korisna je primjena termoterapije. Osim fizioterapijskih procedura, za rehabilitaciju ozljeda n.radialisa je veoma vaţno pravilno pozicioniranje ekstremiteta te upotreba ortopedskih pomagala. The peripheral nervous system, which consists of nerves outside of the central nervous system, is responsible for the transmission of nerve impulses from the brain to the muscles, organs, glands and vessels, and for the transmission of impulses to the brain from sensory receptors of various body parts and sensory organs. Damaging the nerves of this system results in a breakdown of its receptive field. The most common lesions of the peripheral nerves are of the facial nerve, median nerve, nerve peroneus, ulnar and radial nerve. Lesion of the radial nerve is of particular importance because it usually results in a state known as 'The wrist drop', which is characterized with difficult or impossible extension of hand and fingers. Radial nerve is a mixed nerve, which means that the breach does not only damage its function, but also sensors. However, sensory symptoms are minimal and are limited to a small area of the dorsum of the hand. The most common radial neuropathy occurs at the spiral groove,in the middle of the upper arm. This type of nerve entrapment usually occurs in alcoholics, who wake up in the morning with weakened extension of the hand and fingers ('Saturday night palsy'). Less frequent place of compression occurs around the supinator muscle, it's a condition called supinator syndrome. In addition to typical motor deficits, this syndrome is characterized with frequent and painful sensations radiating into fingers. The diagnosis is relatively easy, there are a number of tests that can indicate muscle weakness typical for this nerve injury, but diagnosis is confirmed with signs of EMG denervation. Recovery is extremely good, physical therapy plays an important role in the rehabilitation of these injuries. Most effective results derive from kinesiotherapy and from procedures of electrostimulation and electrotherapy. Kinesiotherapy includes passive, active assisted and active exercise (with resistance and without). Thermotherapy is often used as an initial procedure for reducing pain and increasing muscle contraction. In addition to procedures of physical therapy, proper positioning of the limbs and usage of orthopedic aids is crucial for a successful rehabilitation of the radial nerve.

Osteoarthritis (OA) , jest bolest zgloba, a sam proces zahvaća cjelokupni zglob /kost, hrskavicu, okolne zglobne strukture (ligamenti i mišići). Najčešće nastaje kao posljedica funkcionalnog oštećenja lokomotornog sustava, te je rezultat mehaničkih i bioloških promjena koje narušavaju normalne odnose u zglobu. Potaknuta je različitim čimbenicima rizika kao što su: genetska predispozicija, razvojni poremećaji, endokrini poremećaji, pretilost, učestale traume zgloba. Može zahvatiti svaki zglob u tijelu ali se najčešće ipak javlja na tzv. nosivim zglobovima (koljeno i kuk) , te na malim zglobovima šaka. Glavni klinički znak je bol koja je u početku prisutna u pokretu i opterećenju, a kako proces napreduje bol se javlja i u mirovanju. Ostali simptomi su zakočenost, ograničena pokretljivost, krepitacije u zglobu. Napretkom bolesti javlja se i atrofija okolnih mišića i što dovodi do nestabilnosti i smanjenja pokretljivosti zgloba. Patološki proces bolesti započinje na površini i rubovima hrskavice zgloba koja se mijenja , gubi elastičnost, stvaraju se sitna a kasnije i dublja oštećenja, a zatim se proces širi te zahvaća dijelove subhondralne kosti. Postoje primarne artroze (koje su nepoznatog porijekla) i sekundarne artroze (koje nastaju kao posljedica traume,prirođenih anomalija, metaboličkih i genetskih čimbenika). Dijagnoza osteoartritisa se postavlja na temelju anamneze, kliničkog pregleda bolesnika i radiološke dijagnostike. Najčešće radiološke promjene zgloba su: suženja zglobne pukotine, skleroza subhondralne kosti, cistične promjene subhondralne kosti te osteofiti. Liječenje bolesti se svodi na kombinaciju nefarmakološkog (medicinska gimnastika i fizikalne procedure) i farmakološkog liječenja (analgetici, glukokortikoidi) te operativno liječenje za one bolesnike kojima prijašnje metode liječenja nisu pokazale uspjeha. Osteoartritis koljena je češći u žena srednje i starije životne dobi. Vodeći simptom za osteoartritis koljena jest bol koja se najprije javlja kod hodanja (osobito po stepenicama), pri čučanju i klečanju te kod ustajanja iz sjedećeg položaja. Kako bolest napreduje simptomi postaju izraženiji te su prisutni i u mirovanju. U koljenskom zglobu povremeno dolazi i do otekline zgloba. Osteoarthritis (OA) is a joint disease, and the process affects the entire joint / bone, cartilage surrounding the joint structures (ligaments and muscles). It usually develops as a result of functional impairment of the locomotor system, and is the result of mechanical and biological changes that disrupt normal relations in the joint. Driven by the various risk factors such as genetic predisposition, developmental disorders, endocrine disorders, obesity, and repeated trauma of the joint. It can affect any joint in the body but most commonly occurs through the loaded joints (knee and hip), and the small joints of hand. Main clinical sign is pain that is initially present in the movement and when the joint is loaded, and how the process is progressing pain occurs at rest. Other symptoms include stiffness, limited mobility, and crepitus in the joint. As the disease progress occurs, atrophy of surrounding muscles and ligament mechanism leads to instability and decreased mobility of the joint. Pathological process starts at the surface and edges of the joint cartilage, which is changed, loses elasticity, and creates small and later deeper damage, and then the process expands and engages parts of the subchondral bone. There are primary arthrosis (which are of unknown origin) and secondary arthrosis (resulting from trauma, congenital anomalies, metabolic and genetic factors). The diagnosis of osteoarthritis should be based on history, clinical examination of patients and radiological diagnosis. The most common radiological changes in joints are: narrowing of the joint cavity, subchondral bone sclerosis, cystic changes in subchondral bone and osteophytes. Treatment of the disease is reduced to a combination of non-pharmacological (medical gymnastics and physical procedures) and pharmacological treatment (analgesics, glucocorticoids) and operative treatment for those patients where previous treatments have not proved successful. Osteoarthritis of the knee is more common in women middle aged and elderly. The leading symptom of knee osteoarthritis is pain that first occurs when walking (especially the stairs), in squats and kneeling and in getting up from a seated position. As the disease progresses the symptoms become more pronounced, and are present at rest. The knee joint occasionally comes up swelling of the joint.

Cilj. Prikazati osnovne značajke rehabilitacije šake kod bolesnika sa reumatoidnim artritisom. Ukazati na primjenjive postupke fizikalne medicine u različitim fazama bolesti. Objasniti utjecaj pojedinih fizikalnih metoda na bolešću zahvaćenu šaku. Cilj je sagledati pozitivne učinke fizikalne terapije na život bolesnika po završetku cjelokupne rehabilitacije u odnosu na početno stanje. Metode. Kod funkcionalne procjenu šake kratko sam se osvrnula na metode goniometrije, manualnog mišićnog testa te na mjerenje opsega zglobova. Ukratko sam opisala način izvođenja testiranja, ocjenu i referentne vrijednosti koje bi se trebale dobiti mjerenjem. Opisala sam način vrednovanja upitnika HAQ-Di i DAS 28 te objasnila značenje dobivenih rezultata za funkcionalnu sposobnost šake. Rasprava. Osvrnula sam se na problem kroniciteta bolesti i nepotpunog ozdravljenja po završetku rehabilitacije. Ukazala sam na nepotpuno zadovoljenje osobnih ciljeva pojedinca po završetku rehabilitacije zbog zaostalog hendikepa. Zaključci. Rehabilitacijom kod šake izazivamo mjerljive pozitivne učinke koji bolesniku omogućavaju povratak u svakodnevno i profesionalno funkcioniranje. Uvelike je poboljšana funkcija same šake. Izaziva se osjećaj samopouzdanja, korisnosti i samostalnosti. Sprječava se osjećaj manje vrijednosti i omogućava pacijentu veću neovisnost u svakodnevnom življenju. Objective. To demonstrate the basic features of rehabilitation of hand in patients with rheumatoid arthritis. Indicate the applicable procedures of physical medicine in different stages of the disease. Explain the impact of certain physical methods on disease affected fist. The aim is to look at the positive effects of physical therapy on a patient's life after the end of the overall rehabilitation in regard to the initial condition. Methods. For the functional assessment of the hand I briefly referred to the methods of goniometry, a manual muscle test, and the measurement range of the joints. I briefly described the method of taking tests, assessment and reference values which should be obtained from measurements. I described the method of evaluation questionnaires HAQ-DI and DAS 28 and explained the meaning of the results for the functional ability of the hand. Discussion. I looked at the problem of chronicity disease and incomplete healing after completion of rehabilitation. I pointed to the incomplete satisfaction of personal goals of the individual upon completion of rehabilitation due to residual disability. Conclusion. Rehabilitation of the hand provoke measurable positive effects that allow the patient to return to daily and professional functioning. Has greatly enhanced the function itself fists. It causes a feeling of confidence, convenience and independence. Prevents the feeling of inferiority and allows the patient greater independence in daily life.

Cerebrovaskularne bolesti, bolesti moždanih krvnih žila, predstavljaju danas jedan od najvećih problema suvremenog čovječanstva. Moždani udar, kao najznačajniji predstavnik, treći je uzrok smrtnosti, a prvi uzrok invaliditeta u svijetu. Moždani udar je akutno stanje koje je uzrokovano oštećenjem moždanih struktura okluzijom arterija s posljedičnom ishemijom pripadajućeg područja krvne žile ili stanje nastalo zbog prsnuća krvne žile sa izljevom u moždani parenhim. S obzirom na patofiziološke procese dijelimo ga na ishemijski i hemoragijski, a s obzirom na vrijeme trajanja dijelimo ga na TIA-u, RIND, progresivni moždani udar ili potpuni moždani udar. Simptomi moždanog udara su: smetnje vida u smislu nejasnog vida te pojava dvoslika, trnjenje usana, jezika ili jedne polovice lica i tijela, smetnje govora u smislu poteškoća pri izgovaranju ili razumijevanju govora. motorni deficit s gubitkom snage u jednoj nozi ili ruci ili jednoj polovici tijela, zbunjeno i smeteno stanje, iznenadna jaka glavobolja, dezorijentacija u vremenu i prostoru te promjena stanja svijesti. Zdravstvena njega bolesnika s moždani udarom prvenstveno je usmjerena na otkrivanje i djelovanje na čimbenike rizika moždanog udara, a potom na očuvanje preostalih sposobnosti nakon moždanog udara te na osposobljavanje, najprije, za aktivnosti samozbrinjavanja, a onda i na zadovoljavanje ostalih ljudskih potreba. Primjenom procesa zdravstvene njege postiže se sustavno i dokumentirano praćenje zdravstvene njege bolesnika s moždanim udarom. U ovom radu je ukratko prikazana utvrđena potreba za zdravstvenom njegom, planiranje, provođenje i evaluacija zdravstvene njege s naglaskom na specifičnost zdravstvene njege bolesnika s moždanim udarom. A cerebrovascular diseases, the diseases of the blood vessels, represent today one of the biggest problem of a mankind. The stroke, as one of the most significant representative, is third cause of dead, and the first cause of disability in the world. A stroke is an acute condition which is caused by damage of brain structures following arterial occlusion with subsequent ischemia of respective territories or situation created due to the rupture of blood vessels with hemorrhage into the brain parenchyma. Given the pathophysiological processes work took him to ischemic and hemorrhagic, and given the time and duration divided by TIA, RIND, progressive stroke and complete stroke. Symptoms of stroke include: Vision problems in terms of vague vision or double vision, numbness of the lips, tongue, or one half of the face and body, annoyance speech in terms of difficulty in pronunciation or understanding speech, power deficit with the loss of power in one arm, leg or one half of the body, confused and disoriented state, sudden severe headache especially if it has not occurred, disorientation to time and place and altered mental status. The health care of the stroke victim is direct on the revealing and activity on the risk factors of the stroke and also on the caring of the other abilities after the stroke and also on the capability, in the first place, for the activities of the self care and then on the satisfaction of the other human needs. Application of the process of the nursing care, we can achieve systematic and documented monitoring of the nursing care of stroke victim. In this work, it's shortly presented the confirmation of the needs for the nursing care, planning, leading and evaluation of the nursing care with an accent on the specifics of the nursing care of the stroke victim.

Neuropatije su česta neurološka oboljenja koja se očituju oštećenjima perifernih živaca. Cilj ovog rada je opisati rehabilitaciju neuropatija. Mogu biti uzrokovane traumom, kompresijom, metaboličkim promjenama, toksinima, autoimunim upalama, infekcijama i neoplazma. U dijagnostici se koristi anamneza, fizikalni pregled i elektrodijagnostičke metode. Kod terapije se koriste fiziklni čimbenici, ortopedska pomagala i medikamentna terapija. Neurophaty is common neurological disorder which affects peripheral nerves. I this report rehabilitation of neuropathies will be main topic. This disorder can be caused by trauma, toxins, autoimmune inflammation, infections and tumors. In diagnosis anamnesis, examination and electro diagnostic methods are used. In treatment of neuropathy physical therapy, orthotics and medical treatment is used.

Trajanje i izdržljivost endoproteza drastično se povećava te ih većina bez problema izdrži preko deset godina. Ipak, četiri glavne grupe uzročnika mogu skratiti vijek trajanja proteza a to su: 1)labavljenje proteze odnosno eng. aseptic loosening, 2) bakterijske infekcije, 3) periprotetička osifikacija, 4) artrofibroza. U svrhu sprječavanja navedenih problema od ključne važnosti je pravilno rehabilitirati bolesnika nakon ugradnje endoproteze te kvalitetno educirati bolesnika o indiciranim i kontraindiciranim elementima rehabilitacijskog programa. Prosthesis durability has drastically increased and today most of them can be used for more than 10 years. However,there are four pathogenetic groups of diseases that can decrease prosthesis durability: (1) periprosthetic aseptic loosening (2) bacterial infection (3) periprosthetic ossification, and (4) arthrofibrosis. In order to avoid stated problems it is essential to properly rehabilitate patients after joint replacement. It is also very important to educate the patient of indicated as well as contraindicated elements of the rehabilitation program.

Moždani udar rastući je problem u većini razvijenih zemalja, nalazi se na trećem mjestu uzroka smrtnosti i prvom mjestu uzroka invalidnosti. Upravo zbog te činjenice cilj moga rada bio je prikazati adekvatan rehabilitacijski tretman i bitnost prevencije ovog „tihog ubojice“. Naglasak sam stavila na individualan neurofiziološki pristup. U prvom dijelu sam obradila poglavlja o moždanom udaru, simptomima koji ga karakteriziraju, faktorima rizika, metodama liječenja i posljedicama koje ostavlja. U drugom dijelu su izneseni opći podaci o bolesniku, postojeće tegobe i anamneza, a u trećem dijelu opisane su metode rehabilitacije koje su primjenjene na bolesniku. Stroke is a growing problem in most developed countries, is the third leading cause of death and the primary cause of disability. Due to that fact aim of my article was to show adequate rehabilitation treatment and the importance of prevention of this "silent killer." I put the emphasis on the individual neuropsychological approach. In the first part I dealt with chapters on stroke, the symptoms that characterize it, risk factors, treatment methods and consequences it is leaving. The second part presents general information about the patient, present symptoms and medical history, and the third section describes the methods of rehabilitation that are applied to the patient.

Koljeno je najveći zglob u ljudskom tijelu, najkompliciranije građe i zglob koji se najčešće ozljeđuje. Jedna od težih ozljeda je ruptura prednjeg križnog ligamenta. Pacijent osjeti prasak u koljenu i ima osjećaj kao da mu je koljeno „pobjeglo“ u stranu. Pri ozljedi prisutna je iznimo intenzivna bol praćena nastajanjem otoka i smanjenom pokretljivošću koljena. Dijagnoza se postavlja na temelju kliničkih testova i magnetske rezonancije. Terapija treba započeti odmah, liječenje može biti konzervativno i operativno. Najvažniji cilj rehabilitacije je postizanje punog opsega pokreta i vraćanje izgubljenih funkcija. Rehabilitacija može potrajati i do 6 mjeseci. The knee is the largest joint in the human body, with the most complicated structure. It is wrist that is most harmed. One of the more severe the injury is rupture of the anterior cruciate ligament. The patient felt a crack in his knee and has a feeling thathis knee "escaped" to the side.Symptoms of injury include pain, swelling and reduced mobility of the knee. Diagnosis is based on clinical tests and magnetic resonance imaging. Therapy should begin immediately and the treatment can be conservative and operationally. The most important purpose of rehabilitation is to achieve full range of motion and restore lost function. Rehabilitation can take up to six months.

Sindrom smrznutog ramena kao klinički entitet sastavni je dio izvanzglobnih oboljenja ramenog zgloba poznatiji kao periartritishumeroskapularis ili sindrom bolnog ramena. Patoanatomski gledano, dolazi do skvrčavanja fibrozne zglobne čahure ramena, koja postaje manja i neelastična. Stvaraju se brojne priraslice zglobne čahure ramena, zbog čega pokreti u ramenu postaju progresivno ograničeni i bolni. Općenito, cilj fizikalne terapije je smanjivanje boli, povećanje funkcije i edukacija bolesnika u cilju sprječavanja budućih bolnih epizoda. Ozbiljni slučajevi, koji ni nakon tri mjeseca intenzivne fizikalne terapije ne pokazuju poboljšanje, mogu se liječiti operativnim putem. Iako do danas nije razjašnjen uzrok koji pokreće proces u kojem nastaje sindrom smrznutog ramena, poznajemo vrlo jasnu kliničku sliku i primjereno liječenje. Stoga je cilj ovoga rada definirati, objasniti i prikazati načine liječenja sindroma smrznutog ramena kroz primjer pacijenta. U ovom radu je, kroz konkretni primjer ispitanika prikazan utjecaj konzervativnog i operativnog modaliteta na povrat izgubljene funkcije ramenog zgloba. Nakon 10 dana intenzivne mobilizacije i primjene odgovarajućih metoda fizikalne terapije, nije došlo do povećanja opsega pokreta. Kod pojedinih pokreta zabilježeno je smanjenje opsega pokreta, stoga je operativni zahvat bilo vrlo važno obaviti. Nakon operativnog zahvata (artroskopska prednja, stražnja i donja kapsulotomija oba ramena) dolazi do povećanja opsega pokreta, što je olakšalo daljnju rehabilitaciju. Istraživanja su pokazala da nema efekta primjena samo jednog modaliteta rehabilitacije. Najbolji način liječenja sindroma smrznutog ramena je „timski rad“ procedura fizikalne terapije, prije svega kineziterapije i mobilizacijskih tehnika, u suradnji sa farmakološkim lijekovima (intraartikularnim injekcijama kortikosteroida, NSAR...) koji smanjuju izrazito bolne senzacije u pojedinim fazama bolesti. Frozen shoulder syndrome as a clinical entity is an integral part extra-articular shoulder joint disease known as periartritis humeroskapularis (PHS) or painful shoulder syndrome. Pathoanatomically, there is a contraction of the fibrous joint of shoulder capsule, which becomes less and inelastic. Created numerous adhesions shoulder joint capsule, causing movements in the shoulder become progressively restricted and painful. In general, the goal of physical therapy is to decrease pain, increase the functionality and prevent future pain episodes. Serious cases, that even after three months of intensive physical therapy did not show improvement, can be treated surgically. Although it has not clarified the cause that initiates the process that creates the frozen shoulder syndrome, we know clear clinical picture and the appropriate treatment. Therefore, the aim of this thesis is to define, explain and present methods of treatment of frozen shoulder through the example of a patient. In this thesis, through a concrete example of the respondents to show the influence of conservative and operative modalities on recovering the lost function of the shoulder joint. After 10 days of intense mobilization and application of appropriate methods of physical therapy, there was no increase range of motion. In some movements showed a decrease in range of motion, so the surgery was very important to do. After surgery (arthroscopic front, rear and bottom capsulotomy both shoulders) to an increase range of motion, which facilitated further rehabilitation. Studies have shown that there is no effect of using only one modality of rehabilitation. The best treatment of frozen shoulder is "teamwork" of physical therapy procedures, primarily physical training and mobilization techniques, in collaboration with pharmacological therapy (intra-articular injections of corticosteroids, NSAID, ect.) that reduce extremely painful sensations in different stages of the disease.