1) Frozen shoulder is a condition characterized by pain and loss of shoulder range of motion. It can develop after an injury or gradually without an identifiable cause. 2) Examinations for frozen shoulder focus on selecting evidence-based tests, including evaluating reverse humeroscapular rhythm during abduction-elevation, limited and painful passive external rotation, and capsular pattern restrictions with end feels. 3) Treatment interventions for frozen shoulder aim to improve mobility, reduce pain, and prevent recurrence through techniques like gentle stretching, strengthening, modalities, and manual therapy.

1. Frozen Shoulder
Rey

2. Definisi
• Frozen shoulder merupakan rasa nyeri yang mengakibatkan
keterbatasan lingkup gerak sendi (LGS) pada bahu. Mungkin timbul
karena adanya trauma, mungkin juga timbul secara perlahan-lahan
tanpa tanda-tanda atau riwayat trauma.

3. PATOLOGI FUNGSIONAL/NMSVM
Sugijanto,2017

4. TAGETTOWARD
TISSUE SPECIFIC
CELLS
DISCRIPTIVE – HISTOLOGY - FUNCTION -TOPOGRAPHY –
INTERACTION TO OTHER
BODY STRUCTUR/ANATOMIC
ANALYSIS

5. P
AIN FROM TISSUEORIGIN
SPECIFIC
TISSUE
Inflammation
Ischemic
Contracture
Wound healing process
Nosisensoric sensitization
Inflammation
Hypoxia necrosis
necrosis
Fatique
Sugijanto,2017

6. JOINT MOTIONS IMPAIRMENT
Hypo-
mobility
Capsular
Tendomuscular
Inert
structure
Contracture
Ossification
Non capsular
pattern
Capsular
pattern
Blockade
Loose body
Blockade
Tightness
Contracted
Sugijanto,2017

7. JOINT MOTIONS
Hypermobility &
instability
Ligamenter-
Capsular
Tendomuscular
Bony-
structure
Laxity
Rupture
Joint
hypermobility
Instability
Deformity
Weakness
Rupture
Active
hypermobility
Sugijanto,2017

9. PENGUKURAN
 DASH (Disability of Arm, Shoulder and
Hand)
 PDI (Pain Disability index)
 SPADI (Shoulder Pain Disability Index)
 Shoulder Pain Score
 The McGill Pain Questionnaire (MPQ)
 Oxford Shoulde Scores (OSS)
 The Rotator Cuff Quality Of Life Measure
(RC-QOL)

10. Subacromial Space
• Acromiohumeral Distance (AHD), Acromiohumeral
Interval (AHI)
• Head of humerus to
coracoacromial arch
1. Flatow et al., 1994 : 11.1 mm
2. Gumina et al., 2008 : 9.52 mm
3. Pfirrman et al., 2006 : 8.7 mm

11. Terbentuknya scapulaohumeral rhythm dan
scapulothoracal rhythm melaui kerja otot
yg imbang:
• Kelenturan
• Kekuatan
• Sinkronisasi
Sugijanto, 201
Pada awal grk abduction 0-300 terjadi grk humerus 300
dan scapula pd posisi diam atau sedikit adduction.
• Pada range 300 - 600 terjadi grk proporsional antara
abduction humerus :
• scapula sebesar 2 : 1.
• Selanjutnya pd abduction 600 –1200 juga terjadi
humerus external rotation secara bertahap sebesar 900
menghindari benturan acromion dan head of humerus.
Sementara grk proporsional antara humerus dan
scapula tetap 2 : 1.
• Pd abduction 1200 – 1800 grk proporsional tetap
berlanjut. Pd range ini mulai terjadi grk intervertebral
dan costae bermakna pada akhir ROM
Sugijanto, 201

12. Motion and Stability
Mobility – Elevation
 2/3 dari Glenohumeral
 1/3 dari ScapuloThoracal
 Mobilitas SCJ dan ACJ penting utk fungsi
 Stability dari 2 struktur
 Static Stabilizers - joint morphology and capsuloligamentous complex
 Dynamic Stabilizers - rotator cuff and other muscles
Sugijanto

13. FUNCTIONAL IMPAIRMENT
• Hypomobility
• Suprahumeral dysfunction
• Instability
• Glenohumeral internal rotation deficit
• Scapular dysfunction

14. Functioning, and disability
Anatomic impairment
Cuff ms
tightness
Functional
impairment
Activity
limitation
Participation
restriction
Pain
Muscle
imbalance
Muscle
Scapulo thoracal
muscle weakness
Vascular
Micro circular
constriction
GH Capsels
Inter fiber
adhesion
Contracture, anterior
- inferior capsel most
contracted
Activity with
mobility/ADL
Driving
Work
Sport
Recreation
SHOULDER DISABILITY AKIBAT IDIOPHATIC
FROZEN SHOULDER
Constextual factors
Internal
factors
External
factors
Capsular
pattern
Stretched
pain
Chronic
inflamation
Autonom
system
Sympathic
hyperactivity
AC Capsels
Nerves
Nocisensoric
Hypomobility
Hyperalgesia
Sugijanto,2017

15. PEMERIKSAAN FISIOTERAPI YG DIBUTUHKAN DIUTAMAKAN PEMILIHAN EVIDENCE UNTUK:
• Pemeriksaan terhadap frozen shoulder:
• Abduction-elevation: Reverse Humeroscapular rhythm
• Passive external rotation: the most limitedPemeriksaan Capsels:
• Passive test other: External rotation < Abduction < internal rotation with elastic end feel.
• Joint Play Movement Test:Taction at end range position
Elastic end feel
• Pemeriksaan panjang otot: Contract relax stretch test terhadap otot-otot bahu:
• Terbatas atau lemah
• Pemeriksaan Otot stabilisator:
• Isometric test
• Sabilizing test
Pemeriksaan Scapular mobility:
• Mobilitas Acromioclavicular joint
• Glenohumeral Abduction-elevation
• Tolak pinggang
• Pemeriksaan mobilitas regio
• cervicothoracalis:
• Melalui gerak bahu dan melalui gerak leher.
• Pemeriksaan
• ULTT (upper limb tension test)

16. Nyeri &
gerak
terbatas
Pasif:Ext rot < Abd < int
rot:elastic-firm e.f.
JPM test:Pain,elastic-firm
end feel
Abd-elevation  Reverse
Humeroscapular Rhythm
Capsular patternHypomobility
Frozen Shoulder
Scratch test:Pain,limited
Sugijanto,2017

17. Capsular pattern Hypomobility Frozen Shoulder

18. Intervensi
• C:UsersLENOVODownloadsTraining D2.pdf

19. Terimakasih