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(1)
Frozen shoulder (adhesive capsulitis) briefly.
 Definition: is stiffness, pain, and limited range of movement in your shoulder.
- It may happen after an injury or overuse or from a disease such as diabetes or a stroke.
The tissues around the joint stiffen, scar tissue forms, and shoulder movements become
difficult and painful. The condition usually comes on slowly (gradual onset), then goes
away slowly over the course of a year or more.

 Causes:
- Frozen shoulder can develop when you stop using the joint normally (immobilization)
because of pain, injury, or a chronic health condition, such as diabetes or a stroke.

Note:
***Any shoulder problem can lead to frozen shoulder if you do not work to keep
full range of motion***

Frozen After surgery or injury.

Shoulder in people 40 to 70 years old.
occurs:
in people with chronic diseases.

More often in women (especially in postmenopausal women) than in men.

 Physical examination: See, feel then move.

- Evaluate pain by VAS.
- Evaluate ROM by AROM followed by PROM.
- Ask patient if there is night pain or no.
- Palpate shoulder area for any sign of inflammation or tenderness or dislocated shoulder.
- Make comparison between affected and non-affected shoulder.
- May physician or DPT needs x-ray to rule out any traumatic cause.
- Assess Flex and Ext.Rot of affected and non-affected shoulder.
- The hallmark of physical examination is loss of both passive and active ROM without
degenerative changes on.X-ray.

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 characteristics of the 3 phases of frozen shoulder:
Phase I - PAIN
Insidious or acute onset.
During activity and rest.
Night pain affecting sleep.
Pain distributed over
deltoid area.
Point of tenderness over
bicipital groove.
Upper back ache due to
compensatory movement
of shoulder girdle.
Phase II – STIFFNESS Phase III. - THAWING
Protective ms spasm. Motion increased
Patient prefers wearing Pain diminished.
sling or rest to support
arm.
Difficult functional Do all functional activities
activities. but may not full ROM.
Pain starts to subside.
Loss of ROM.
Empty end feel
Loss of int rot then ext rot
and flex.

Treatment of frozen shoulder: -

I. Non-operative TTT II. surgical TTT

- Anti-inflammatories drugs. NSAIDs (Most studies

seem to show that corticosteroids may reduce pain
early on better than rehabilitation or placebo but
their benefits are not maintained long term).
- Intra-articular corticosteroid injections. there is some
evidence to indicate there is a short-term benefit with
their use. and also injections performed blindly may be
inaccurate in approximately 60% of cases.
- Capsular distension injections
The joint is injected to its limits with local anesthetic
to attempt to stretch the capsule. This technique is
often poorly tolerated because of pain that is
experienced during the process as the entire shoulder is
not anesthetized from the intra-articular injection.
- Manipulation under anesthesia.
- Physical and manual therapy.
The treatment of adhesive capsulitis
should lead to the operating room
only after a concerted effort at
conservative management has failed
There is not a discrete timeline to
head to surgery. As a general rule
patients should have participated in
some form of therapy for at least 2
months, and shown no progress.
Patients should feel they are not
making progress and have significant
pain and limitations of occupation,
recreation, or sleep to proceed with
surgical intervention.

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 Physical therapy TTT:
- Start with RICE technique if there is inflammation.
- If there is no inflammation start with heat then gentle stretch and mobilization
in cephalon-caudal direction to decrease pain.
- Some techniques of myofascial release and trigger point release in upper
trapezius and deltoid muscle.
3 important stretches:
1. Pendulum swing
- Stand to the side of a table, steady chair, or railing and place the hand of your
uninjured arm on the object for stability.
- Gently lean forward without rounding the back and allow the affected arm to dangle
freely. Then, lightly move this arm forward and back.
- Starting in the same position, move your arm in and out (side-to-side).
- Starting in the same position, move your arm in small circles. Start in a clockwise
motion, then reverse and do it counterclockwise.
- Repeat the exercise with the other arm.

2. Crossover arm stretch

- Stand up straight and relax your shoulders. Take a few deep breaths if you need to
relax.
- Stretch the affected arm across your chest, but below your chin; reach as far as possible.
- The healthy arm helps by holding the elbow area of the affected arm.
- When performing this exercise, you should feel a stretch—not pain.
- Repeat the exercise with the other arm.

3. Anterior Shoulder & Chest Stretch

- Stand next to a wall with one arm outstretched behind you parallel to the ground with
your palm on the wall. Slowly turn your body away from the wall.

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 MWM for shoulder joint:

Inferior glide of shoulder jt.

MWM in pattern of shoulder

flexion

Sub acromial mobilization.

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 Graston tools for shoulder trigger points:

 Dry cupping for frozen shoulder ROM:

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 Kinesio taping for shoulder pain.

Thank you… ANE

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