Frozen Shoulder.pdf

dr Putu Sukedana S.Ked; PutuAditya Mahardika, S.Ft, Ftr
Budiarsana Foundation with FisioterapiJembrana
@Sukedanapt @Fisioterapi.Jembrana

Case
1. Chan, Hui Bin Y; Pua, Pek Ying; How ,Choon How . Physical therapy in the management of frozen shoulder. Singapore Med Journal 2017;58 (12):685-689

 “A condition of uncertain aetiology, characterized by significant
restriction of both active and passive shoulder motion that occurs in
the absence of a known intrinsic shoulder disorder”1,2
 Typically severe pain worsens at night, insidious shoulder stiffness, and
near-complete loss of passive and active external rotation of the
shoulder1,2
 Frozen shoulder often progress in three stages: the freesing (painful),
frozen (adhesive), and thawing phases1,2
Frozen Shoulder/Adhesive capsulitis
2. M aund,E; Craig, D; Suekarran, S; Neilson, AR; Wright,K; Brealey,S; Dennis, L; Goodchild,L; Hanchard, N; Rangan, A; Richardson, G; Robertson,J; M cDald,C. M anagement of fro
zen shoulder : a systematic review and cost-effectiveness analysis. Health Technology Assessment 2012;Vol. 16 No 11

 It was first described in 1875
by the French pathologist
Duplay “peri-arthrite scapula-
humerale”
 1934, by American Surgeon
EA Codman “Frozen
shoulder”
Maund, E; Craig, D; Suekarran, S; Neilson, AR; Wright, K; Brealey, S; Dennis, L; Goodchild, L; Hanchard, N; Rangan, A; Richardson, G; Robertson, J; McDald, C. Man
agement of frozen shoulder : a systematic rev iew and cost-effectiv eness analysis. Health Technology Assessment 2012; Vol. 16 No 11
Sumber Gambar: https://1stchoicesportsrehab.com/frozen-shoulder-faster-treatment/

 Frozen shoulder can be classified as primaryor secondary1,2
 Primary idiopathic frozen shoulder is often associated with other
diseases and condition like diabetes mellitus, hemiparesis, etc1,2 The
incidence of frozen shoulder is reported to be 10-36% amongst
people with diabetes2
 Several studies have confirmed higher prevalence (27.2%) and
incidence (10.9%) of hypothyroidism in patients with FS2
 Secondary frozen shoulder can occur after shoulder injuries or
immobilisation1,2 The proportion of frozen shoulder attributed to
trauma varies (9-33%)2
Frozen Shoulder/Adhesive capsulitis
1. Chan, Hui Bin Y; Pua, Pek Ying; How ,Choon How . Physical therapy in the management of frozen shoulder. Singapore Med Journal 2017;58 (12):685 -689

Kelley,M artin J;M cclure,Phillip W; Leggin, Brian G. Frozen Shoulder: Evidence and a Proposed M odel Guiding Rehabilitation. Journal of Orthopaedic& Sports Physical Therapy 2009;
39 (2): 135-148

 Frozen shoulder is estimated to affect 2-5% of general population1 A
large UK-based primary care study found that frozen shoulder
affected 8.2% of men and 10,1% of women of working age2 More
often occurs in women than men1,2
 Most commonly affects those in their fourth to six decades of life1,2
 Precise etiology remains unclear, but elevated serum cytokines level
as a part of process3
Epidemiology and Etiology Frozen Shoulder/Adhesive capsulitis
3. Kelley,M artin J;M cclure,Phillip W; Leggin, Brian G. Frozen Shoulder: Evidence and a Proposed M odel Guiding Rehabilitation. Journal of Orthopaedic & Sports Physical Therapy 2
009;39 (2): 135-148

MANAGEMENT FROZEN
SHOULDER/ADHESIVE CAPSULITIS
 Pharmacology
Treatment
First Line: NSID oral OR glucocorticoid or
intraarticular injection1
OR MULTIMODAL ANALGESIA
 Non
Pharmacology
Treatment
Physiotherapy
or Surgical
 Combination NSID + Physical therapy more effective than NSID alone1
 Combination intra-articular corticosteroids + Physical therapy, better outcomes compared to intra-articular
corticosteroids alone.
tIntra-articular corticosteroid injections are more effective than placebo1,2
 Oral corticosteroid produce a small short-term benefit in pain relief and improved range of motion2
2. Ramirez, Jason. Adhesive capsulitis: Diagnosis and M anagement. American Family Physician,2019: 99 (5): 297-300

Pharmacology
Treatment
•Analgesic: NSID oral OR glucocorticoid or intraarticular
injection (Methylprednisolone acetate or Triamcinolone
hexacetonide)1,2
Non
Pharmacology
Treatment
•Heat or ice pack
•Pendulum exercise, passive supine
forward elevation, passive external
rotation, and active assisted range of
motion in extension, horizontal
adduction, and internal rotation 1-5
seconds(figure 2)1
Freezing phase
1. Chan, Hui Bin Y; Pua, Pek Ying; How ,Choon How . Physical therapy in the management of frozen shoulder. Singapore Med Journal 2017;58 (12):685 -689
zen shoulder : a systematicreview and cost-effectiveness analysis. Health Technology Assessment 2012;Vol. 16 No 11

Chan, Hui Bin Y; Pua, Pek Ying; How ,Choon How . Physical therapy in the management of frozen shoulder. Singapore Med Journal 2017;58 (12):685 -689
@Sukedanapt
@Fisioterapi.Jembrana

Pharmacology
Treatment
injection1
Non
Pharmacology
Treatment
•Heat or ice pack
•Figure 2 + 3
Frozen phase

Chan, Hui Bin Y; Pua, Pek Ying; How ,Choon How . Physical therapy in the management of frozen shoulder. Singapore Med Journal 2017;58 (12):685 -689
“Physio in the second stage is focused on increasing and restoring the range of
motion of the shoulder joint. Through a combination of specific manual therapy,
stretching, exercise programs."

Pharmacology
Treatment
injection1
Non
Pharmacology
Treatment
•Heat or ice pack
•Figure 2 + 3 with a longer holding
duration, within tolerated
boundaries
•“The physio will focus on returning
to the "normal" mechanism of the
shoulder body and returning the
patient to normal, day-to-day
activities, without pain. "
Thawing phase

(THAWING PHASE )
1. Stretching. The stretching given will focus on certain directions and
positions that are still limited.
2. Therapy Manual. The therapeutic manual is given in very specific
positions and ranges which are still problematic.
3. Strengthening Exercises. Specific strength training is given according
to the patient's goal to return to his daily life.
4. Return to work/sports. The exercises provided are specific to the
work and specific recreational activities the patient does.

• Standing by the table with hands on
healthy shoulders on the table
• Bend your hips about 75 to 90 degrees
and let the affected arm hang down to
the floor.
• Shift your weight from side to side,
allowing your arms to swing freely from
side to side.
• Shift your weight back and forth, allowing
your arms to swing freely back and forth.
• After that, move the body so that the
arms swing in a circle. Keep the circle
small.
Standing Pendulum exercise

“Grab the bottom of the towel
with the arm that hurts and pull
it toward the lower back with
the arm that doesn't hurt. Do
this 10 to 20 times a day.”

“Use the healthy arm to lift the sore arm at the
elbow, and bringit up and across the body,
applying gentle pressure to stretch the shoulder.
Hold the stretch for 15 to 20 seconds. Do this
10 to 20 times per day.”
“Usingthe healthy arm, lift the affected arm
onto the rack at chest level. Bend the knees
gently, open the armpits. Slightly deepen your
knee bends, gently stretch your armpits, then
straighten them. With each knee bent, stretch
a little further. Do this 10 to 20 times every day.”

Physiotherapy Modalities / Tools
“The electrical impulses in TENS can
reduce pain signals going to the
spinal cord and brain, TENS can also
stimulatethe productionof endorphin"
TENS
KINESIOLOGY TAPING
“Kinesiology Taping provides safety
and stability to the affected shoulder
joint, and at the same time reduces
pain. Kinesio Tape can increase the
support of the shoulder, thus allowing
the shoulder to move without
excessive pain."

THANK YOU
 Almighty God
 Dedication to: Alm Wayan Budiarsana, my family for their support
 My teachers from elementary until medical faculty
 My senior who share their experienced to treat patients with Frozen Shoulder
 Thank you to Mr Aditya Mahardika (professional physiotherapist) for
collaboration
 This slides still needs to be improved. If there is any input/opinion, we are welc
ome with that

Frozen Shoulder.pdf

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