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Frozen Shoulder

Frozen Shoulder
Adhesive capsulitis, also known as frozen shoulder, is a condition characterized by pain and significant loss of both active range of motion (AROM) and passive range of motion (PROM) of the shoulder. While many classification systems are proposed in the literature, frozen shoulder is most commonly classified as either primary or secondary. Primary frozen shoulder is idiopathic in nature, and radiographs appear normal. Secondary frozen shoulder develops due to some disease process, which can further be classified as systemic, extrinsic, or intrinsic. Systemic secondary frozen shoulder develops due to underlying systemic connective tissue disease processes, and causes include diabetes mellitus, hypo- or hyperthyroidism, hypoadrenalism. Extrinsic secondary frozen shoulder occurs from pathology not related to the shoulder, such as cardiopulmonary disease, CVA, cervical disc pathology, humeral fracture, and Parkinsons. Intrinsic secondary frozen shoulder results from known shoulder pathology, including but not
limited to rotator cuff tendinopathy, GH arthropathy, and AC arthropathy.
Frozen shoulder usually affects patients aged 40-70, with females affected more than males, and no predilection for race. There is a higher incidence of frozen shoulder among patients with diabetes (10-20%), compared with the general population (2-5%). There is an even greater incidence among patients with insulin dependent diabetes (36%), with increased frequency of bilateral shoulder involvement.
 
Problem List(identify impairment(s) and/or dysfunction(s)
Impairments:
1. Pain
2. Impaired joint play and ROM in capsular pattern
3. Postural deviations such as protracted scapula and anterior tipping of the scapula and rounded shoulders
4. Decreased arm swing during gait
5. General muscle weakness, poor endurance in glenohumeral (GH) musculature with resultant overuse of the scapular muscles.
 
Prognosis:Adhesive capsulitis can last 12 to 18 months, with 3 distinct phases. The first phase can last 2-9 months, the second phase 4-12 months and the last phase, the thawing phase, from 6-9 months.
 
Goals (measurable parameters and specific timelines to be included on evaluation form):
The patient will:
1. Demonstrate knowledge of self management of symptoms
2. Demonstrate independent knowledge of home exercise program
3. Increase ROM of all affected motions to equal ROM on the unaffected side
4. Demonstrate normal postural alignment
5. Demonstrate normal UE motion during gait
6. Demonstrate highest level of muscular performance on involved UE and scapular musculature.
 
Interventions most commonly used for this case type/diagnosis:
This section is intended to capture the most commonly used interventions for this case type/diagnosis. It is not intended to be either inclusive or exclusive of appropriate interventions.
1. ROM exercises including pendulum exercises, PROM, AAROM, AROM
2. TENS for pain relief
3. Strengthening exercises within pain free range
4. Joint mobilization: grades I-II used in the early stages to inhibit pain and to improve joint nutrition, grades III-IV to increase tissue extensibility
5. Moist heat
6. Stretching
7. Muscle reeducation to regain normal GH and scapulothoracic biomechanics.
 
Frequency & Duration:
Frequency and duration of treatment are both dependent on the stage that the patient is in. In the initial stages, physical therapy (PT) 2-3 times per week for instruction in home exercise program, patient education, postural awareness education so the patient is able to self manage symptoms and prevent secondary impairments in the UE and shoulder girdle musculature. In the later stages, when the patient is thawing, PT 3-4 times per week.
 
Patient / family education:
1. Time Frames of healing and of each stage
2. Pathology and natural history of the disorder
3. Role of PT in rehabilitation
4. Home exercise program including strengthening and AROM/AAROM/PROM
5. Pain management techniques.

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