DR M S GOUD
PROFESSOR OF ORTHOPAEDICS
GANDHI MEDICAL COLLEGE
DEFINITION:it is a syndrome defined in its purest
sense as an idiopathic pain ful restriction of shoulder
movements resulting in global restriction of gleno
CODMAN in 1934 coined the term frozen shoulder
and described as “difficult to define,difficult to
treat,difficult to explain”.
Slow onset of pain near the insertion of the deltoid.
Inability to sleep on the affected side.
Pain relatively more in the night.
Restriction of abduction and external rotation
followed by global restriction.
Normal radiological appearance.
Runs for 1 to 3 years.
It is divided in to three phases
a)freezing phase (2-6 months)
b)frozen phase (4 -12 months)
c)thawing phase (4 -18 months)
If not treated will end up in permanent restriction of
Not common before 4th decade.
More common in women.
Non dominant extremity.
More common in hyper anxiety personalities with low
Primary : idiopathic.
Secondary contributing factors
1)injury not treated properly
2)after shoulder surgery
5)poor posture-specially when recovering from
chronic illnesses like CVA,MI etc…
IT HAS TO BE DIFFERENTIATED FROM OTHER
PAIN FUL SYNDROMES.
2) osteo arthritis.
4)painful arc syndrome.
5) rotator cuff injuries
3)intra articular steroid(methyl prednisolone)
4)intra articular saline injection with breakage of the
capsule fibres and adhesions(brisement)
5)closed manipulation under G.A.
1)Electro therapy (ultrasound,IFT).
3)exercises to improve flexibility and strength.
4)ice and heat treatment.
5)soft tissue massage.
Councelling and motivation.
Interferential therapy:it is a
current used for thereupetic
purposes obtained by passing
two medium frequency
currents where the currents
intersect with tissue to
produce a new current.
ULTRA SOUND THERAPY:
Mechanical vibrations of sound waves of frequency
ranging from 0.5 to 5 MHZ.
The theurepetic ultra sound works on reverse piezo
THERMAL EFFECTS: are useful for treatment.
a)increased extensibility of connective tissue.
b)decreased joint stiffness and muscle spasm.
d)promotes healing of tissues.
MANAGEMENT OF FREEZING
STAGE( STAGE 1)
Gentle physiotherapy (mostly pendular exercises)
Intra articular methyl prednisolone
MANAGEMENT OF FROZEN AND
Ideal for active and passive physiotherapy
Distension of the shoulder joint with 50 -100 ml of
saline will break some fibres of the
MANIPULATION :if there is no response with above
PHYSIOTHERAPY:short period for 5 to 10 min per
hour around 10 cycles per day is better than a
continuous physiotherapy for long time.
Application of heat before physiotherapy( ultrasound
and IFT ) will cause vasodilatation that helps in
Application of ice after physiotherapy
(vasoconstriction) reduces the inflammation.
Patients limb should be kept
in 160 degrees of abduction
and 90 degrees of external
rotation for 48
hours(ROBERT ET AL).
Patient should have an inter
scalene block catheter insitu
for 48 hours.
COMPLICATIONS OF MUA:
Fracture surgical neck of humerus.
Rupture of sub scapularis.
Rupture of long head of biceps.
FACTORS THAT MAY INCREASE RISK OF
Recent chronic illness
Chronic smokers and alcoholics
Previous shoulder surgery.
It’s a vascular based inflammatory pathology with
formation of adhesions.
Natural history-variable duration.
chronic pain with stiff shoulder with restriction of
daily living activities
NO SINGLE TREATMENT REGIME HAS BEEN
PROVED TO BE THE BEST SOLUTION.
What ever regime we adopt “PHYSIOTHERAPY IS
THE MAIN STAY OF THE TREATMENT”.
There is a role for surgical release (arthroscopy) for
chronic and resistant cases.