This document discusses periarthritis shoulder, also known as frozen shoulder or adhesive capsulitis. It has three stages: a painful freezing stage with night pain and limited range of motion, an adhesive frozen stage with more loss of shoulder motion, and a recovery thawing stage with gradual improvement in range of motion. Physiotherapy aims to reduce pain, improve mobility and strength, and increase capsular extensibility through techniques like pendular exercises, towel stretches, and special tests like the shoulder shrug and Apley scratch tests to assess range of motion. The condition involves inflammation around the shoulder joint capsule and surrounding soft tissues, restricting both active and passive shoulder motion.

1. PERIARTHRITIS SHOULDER /
FROZEN SHOULDER /
ADHESIVE CAPSULITIS

2. CONTENTS
• DEFINITION
• TYPES
• CLINICAL FEATURES
• RED FLAGS
• STAGES
• SPECIAL TEST
• PHYSIOTHERAPEUTIC MANAGEMENT

3. INTRODUCTION
• IT IS ALSO CALLED AS FROZEN SHOULDER / ADHESIVE CAPSULITIS
• IT IS A CHRONIC INFLAMMATORY DISORDER OF SHOULDER AND SURROUNDING SOFT TISSUE
• THERE IS INFLAMMATION OF TISSUE AROUND JOINT CAPSULE
• CHARACTERIZED BY INITIALLY PAINFUL AND LATER PROGRESSIVELY RESTRICTED ACTIVE AND PASSIVE GLENOHUMERAL (GH)
JOINT RANGE OF MOTION
• AGGRAVATED BY UNCONTROLLED DIABETES MELLITUS ,CARDIOVASCULAR DISEASE AND REFLEX SYMPATHETIC DYSTROPHY

4. TYPES
PRIMARY
• PRIMARY - ONSET IS GENERALLY IDIOPATHIC (IT
COMES ON FOR NO ATTRIBUTABLE REASON)
SECONDARY
• SECONDARY - RESULTS FROM A KNOWN CAUSE,
PREDISPOSING FACTOR OR SURGICAL EVENT
• POST SURGERY, POST-STROKE AND POST-INJURY. WHERE
POST-INJURY, THERE MAY BE AN ALTERED MOVEMENT
PATTERN TO PROTECT THE PAINFUL STRUCTURES, WHICH
WILL IN TURN CHANGE THE MOTOR CONTROL OF THE
SHOULDER, REDUCING THE RANGE OF MOTION, AND
GRADUALLY STIFFENS UP THE JOINT.

5. CLINICAL FEATURES
• DIFFUSE PAIN AND RESISTANCE OF MOVEMENT
AT SHOULDER :, EXTERNAL ROTATION
• CARDINAL SIGN – STUBBORN LACK OF ACTIVE
AND PASSIVE MOVEMENT

6. RED FLAGS
• DIABETES MELLITUS
• STROKE
• THYROID DISORDER
• SHOULDER INJURY
• DUPUYTREN DISEASE
• PARKINSON'S
• COMPLEX REGIONAL PAIN SYNDROME
• AVASCULAR NECROSIS
• TUBERCULOSIS
• SHORTNESS OF BREATH, SEVERE COUGH, ANY COMPROMISES
TO THE QUALITY OF THE BREATH
• METASTATIC DISEASE
• RHEUMATISMS
• MULTIPLE JOINT INVOLVEMENT
• FEVER, CHILLS, SEVERE PAIN
• HISTORY OF CANCER
• ANY SUSPICION OF A SYSTEMIC PATHOLOGY OR CONDITION

7. STAGES
Gradual onset of
shoulder pain at rest
with sharp pain at
extremes of motion, and
pain at night with sleep
interruption which may
(2-9 months)
Pain starts to subside,
progressive loss of GH
motion .Pain is apparent
only at extremes of
movement.
(4-12 months)
spontaneous,
progressive
improvement in
functional range of
motion
(5 to 24 months)
Stage -1
Painful
/Freezing Stage
Stage -2
Adhesive /
Frozen Stage
Stage – 3
Recovery
/Thawing Stage

8. SPECIAL TEST
SHOULDER SHRUG SIGN
INABILITY TO LIFT THE ARM TO 90°
ABDUCTION WITHOUT ELEVATING THE
WHOLE SCAPULA OR SHOULDER
GIRDLE)

9. APLEY SCRATCH TEST
ASSESS SHOULDER MOVEMENT AND RANGE
OF MOTION, PUTTING THE JOINT THROUGH
INTERNAL ROTATION, ADDUCTION,
ABDUCTION, AND EXTERNAL ROTATION

10. PHYSIOTHERAPEUTIC MANAGEMENT
• AIM :-
1. TO REDUCE PAIN
2. IMPROVE MOBILITY OF SHOULDER
3. IMPROVE THE STRENGTH OF MUSCLES
4. INCREASE EXTENSIBILITY OF THE THICKENED AND CONTRACTED CAPSULE OF JOINT

11. Stage 1

12. Stage -2

13. Stage -3

14. Pendular exercise

17. Shoulder towel stretch

19. THANK YOU