Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by stiffness and pain in the shoulder joint. It typically develops slowly over three stages - freezing, frozen, and thawing. The freezing stage involves increasing pain with movement over 6-9 months, while the frozen stage sees worsening stiffness for 4-12 months. Treatment focuses on physical therapy, manual therapy techniques like stretching and mobilization, medications, and sometimes surgery.

2. Frozen Shoulder
Workshop # 1

3. Definition:
Frozen shoulder, also known as adhesive capsulitis, is a
condition characterized by stiffness and pain in your
shoulder joint.
• Adhesive capsulitis as the pathology involves the
capsule of the joint

4. • Incidence is 2%
• Seen in women more commonly than men during the 5th to 7th
decade
• Bilateral involvement occurs in 10 to 40 % of cases
• Does not usually recurrence in the same shoulder
• Frozen shoulder typically develops slowly, and in three
stages.

5. Shoulder Anatomy
1. HUMERUS
2. SCAPULA
3. CLAVICLE
4. GLENOID
5. ACROMION
6. HEAD OF HUMERUS
7. CORACOID

6. Surface Anatomy

7. SHOULDER COMPLEX
1. Gleno-Humeral Joint
2. Sterno-Clavicular Joint
3. Acromio-Clavicular Joint
4. Coroco-Clavicular Joint
5. Scapulo-Thoracic Joint

8. BIOMECHANICS

9. What is Stiff?
• Patient - “I cant move my shoulder
as well ‘cos it hurts”
• Us - Reduction in active and passive
glenohumeral joint movement
compared to the contralateral side

10. •3 N’s
• Neck (or neural)
• Not moving - true stiffness
• Nasty (Infection, Malignancy)

11. Neck
• Radicular pain - extending below
elbow, occasionally medial scapula
(c3/4)
• Shoulder should be painfree to
passive ROM

12. True Stiffness
• Reduction in Passive and active
glenohumeral joint movement
• Limitation due to bony abnormality
• Osteoarthritis
• Missed Dislocation

13. Nasty
• Night and Unremitting
pain
• Red flags
• history of malignancy
• unexplained weight loss

14. Causes
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• Lundberg classified in to primary and
secondary frozen shoulder
PRIMARY FROZEN SHOULDER
No inciting event, normal plain radiographs
and no findings other than loss of motion
SECONDARY FROZEN SHOULDER
Precipitant traumatic event

15. PRIMARY FROZEN SHOULDER
15
• No inciting event but INTRINSIC AND
EXTRINSIC predisposing factors present
• INTRINSIC factors like age between 40 and 60
years of age, female sex, Diabetes mellitus
• EXTRINSIC factors may include immobilization
and faulty body mechanics

16. Stages Of Frozen Shoulder
• 1. Freezing / Painful
• 2. Frozen / Stiffening
• 3. Thawing / Recovery

18. Freezing stage:
 Develop a pain in your shoulder any time you move it.
 It slowly gets worse over time and may hurt more at
night.
 This can last anywhere from 6 to 9 months.
 You’re limited in how far you can move your shoulder.

19. Frozen stage:
 Your pain might get better but your stiffness gets worse.
 Moving your shoulder becomes more difficult and it becomes
harder to get through daily activities.
 This stage can last 4-12 months.

20. Thawing stage:
• Your range of motion starts to go back to normal.
•This can take anywhere from 6 months to 2 years.

21. DIFFERNTIAL DIAGNOSIS
1. Shoulder Osteoarthritis
• PROM will not be limited.
• limitations with flexion.
• Radiography
2. Bursitis
• most motions being painful.
• amount of PROM achieved.
• will have a larger PROM But painfull.
3. Posterior Dislocation
• Unable to fully supinate the arm while flexing the shoulder.
4. Rotator Cuff Pathologies
• No capsular pattern.
• Radiology is usefull.
5. Parsonage-Turner Syndrome
• inflammation of the brachial plexus.
• painful restrictions of all motions.
• neurological problems

22. DIAGNOSIS
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• Campbell decribes presence of 3 features to diagnose
frozen shoulder:
1.Internal rotation restricted upto the point when the
patient cannot touch beyond his sacrum
2. 50% loss of external rotation
3. < 90 degrees of abduction

23. Treatment
 Counselling
 Physical therapy
 Surgery
• Manipulation Under Anesthesia.
• Arthroscopic Capsular Release.
 Mediction:
• NSAIDS
• Anti-inflammatory
• Steroid injection

24. Manual Therapy
1. Anterio- Posterior Glide
2. Inferior Glide
3. Scapular Mobilization
4. Maitland Mobilization Grades
5. Movement With Mobilization
6. Muscle Energy Technique
7. Stretching
8. Strengthing
9. Functional Movement
10. Home Plan

25. Anterior Glide

26. Posterior Glide

27. Inferior Glide

28. Scapular Mobilization

29. Maitland Mobilization

30. Movement with Mobilization (ER)

31. Movement with Mobilization (IR)

32. Muscle Energy Technique (IR)

33. Muscle Energy Technique (AD)

34. Stretching

35. Strengthening

36. Functional Movement

37. HomeAdvice
 Getting the arm up while lying down.
 Getting the arm up overhead while sitting down.
 Getting the arm to externally rotate while lying
down.

38.  Getting the arm up the back.
 Getting the arm across the body.
 Pendulum exercise.
 Wall ladder / climbing.
 Catch something from away.
HomeAdvice

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