The document discusses shoulder rehabilitation for frozen shoulder. It describes the shoulder joint complex and what frozen shoulder is. Frozen shoulder causes pain and stiffness in the shoulder joint from thickening of the joint capsule. Treatment focuses on pain relief initially, followed by physiotherapy to regain mobility through exercises and joint mobilizations. The physiotherapy management involves protection, control of motion, and return to function phases to restore range of motion and strength.

1. Shoulder
Rehabilitation
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2. What is Shoulder Joint?
The shoulder complex involves 3 physiological joints and one floating joint:
•Glenohumeral (GH) joint,
•Acromioclavicular (AC) joint
•Sternoclavicular (SC) joint
•Scapulothoracic (ST) joint - is not a true joint
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3. The ball at the top of the arm bone (‘humerus’)
fits into the shallow socket (‘glenoid’) which is
part of your shoulder blade (‘scapula’). There is a
loose bag or capsule which surrounds the joint.
This is supported by ligaments and muscles.
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4. What is ‘Frozen Shoulder’?
Typically the joint is stiff and initially painful, often starting without an apparent cause. The
loose bag (capsule) around the shoulder joint becomes inflamed. The bag then appears to
tighten or shrink. This tightening combined with the pain restricts the movement.
It is most common in people between the ages of 40 and 60 years and has been estimated to
affect at least one person in 50 every year.
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5. Why does it occur?
A primary frozen shoulder is when the exact cause is not known. It is
more common in people with diabetes and with a thyroid gland
problem. About 15% of patients link it to a minor injury to the
shoulder.
A secondary frozen shoulder can develop if the shoulder area is kept
still for some time, for example, after a stroke or heart attack. It can
also occur after major injury or surgery to the shoulder. Some experts
think the inflammation starts with a problem in the shoulder itself,
others feel it is related to factors away from the shoulder (e.g. stiff
neck, certain diseases).
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6. What is likely to happen?
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7. Treatment
•The passage of time is the main treatment!
•During the painful phase the emphasis is on pain-relief. Therefore pain-killing tablets and anti-
inflammatory tablets may be prescribed. Physiotherapy at this stage is directed at pain relief (heat,
cold and other pain relieving modalities such as electrotherapy). Forcing the joint to move can make
it more painful and is best not pursued.
•Once stiffness is more of a problem than pain, physiotherapy is indicated. You will be shown specific
exercises to try and get the ball and socket moving. In addition, the therapist may move the joint,
trying to regain the normal glides and rolling of the joint. These are known as joint mobilizations.
Muscle based movement techniques may also be used.
•Hopefully, as the recovery phase starts you will find that the movement gradually increases. This,
again, can be a useful time to have physiotherapy to help maximize the movement.
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MaryamSportsPT

8. Patient Presentation
•Night pain and disturbed sleep during acute flares
•Pain on motion and often at rest during acute flares
•Mobility: decreased joint play and ROM, usually limiting external rotation and abduction with some limitation of
internal rotation and elevation in flexion
•Gait: Decreased arm swing during gait
•Posture: possible faulty postural compensations with protracted and anteriorly tipped scapula, rounded shoulders,
and elevated and protected shoulder
•Muscle Performance: general muscle weakness and poor endurance in the glenohumeral muscles with overuse of
scapular muscles leading to pain in the trapezius and posterior cervical muscles
•Guarded shoulder motions with substitute scapular motion, especially elevation.
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9. Activity Limitations
▪Inability to reach overhead, behind head, out to the side, and behind back leading to difficulty
dressing (putting on a jacket or coat or in the case of women, fastening undergarments behind
their back), reaching hand into back pocket of pants (to retrieve wallet), reaching out a car
window (to use an ATM machine), self-grooming (combing hair, brushing teeth, washing face),
and bringing eating utensils to the mouth
▪Difficulty lifting heavy objects above shoulder level
▪Limited ability to sustain repetitive activities
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10. Physiotherapy Management- Protection
Phase
Educate
Rest via Sling
Grade I & II
Mobilizations
Codman’s
Exercises
Gentle Muscle
Setting
US/ TENS
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11. Self- Resisted Isometrics
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12. Isometrics- Using Wall
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13. Physiotherapy Management- Control
Motion Phase
ROM
Stretch Glides
Codman’s
Exercises
Stretching
Correct Faulty
Mechanics
Mobilization
With Movement
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14. Self Glide- inferior & anterior
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15. Self Stretching
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18. DR. MARYAM NADEEM
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20. Shoulder MWM
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22. Codman’s Exercises
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23. Physiotherapy Management- Return to
Function Phase
Strength and
Flexibility
Prepare for
Functional Demands
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25. DR. MARYAM NADEEM
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