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Developed by Alex Petruska, DPT and the Massachusetts General Hospital Sports Medicine Service Adapted from: The American Academy of Orthopedic Surgeons, AAOS Online Service, 2003. Rowe,CR, Leffert, RD: "Idiopathic Chronic Adhesive Capsulitis". The Shoulder. Ed.
Frozen Shoulder – Adhesive Capsulitis
Brett Sanders, MD Center For Sports Medicine and Orthopaedic 2415 McCallie Ave. Chattanooga, TN (423) 624-
If you're having trouble lifting your arm above your head, reaching across your body or
behind your back, and have limited motion in your shoulder, it may be an early symptom of frozen shoulder. Chronic idiopathic adhesive capsulitis is a condition of the shoulder with several unusual characteristics:
- Its cause is unknown.
- It does not occur in other joints or parts of the body.
- Range of motion is limited globally, that is all planes of motion are affected by loss of motion.
- It is usually a self-limited syndrome, when untreated, passing through three distinct phases of three to four months each: o The freezing phase o The frozen phase o The thawing phase
- In most case; the shoulder and its tissues recover completely with time, although there may be some residual restriction in shoulder motion in some cases.
- It may involve the opposite shoulder, but rarely recurs in the same shoulder.
- X-rays are usually normal
- Frozen shoulder is not associated with arthritis or malignancies.
- Affects more women than men.
- Usual onset begins between ages 40 and 65.
- Affects approximately 10% to 20% of diabetics.
- Other predisposing factors include: - A period of enforced immobility, resulting from trauma, overuse injuries or surgery. - Hyperthyroidism. – Cardiovascular disease - Clinical depression. - Parkinson's disease.
Frozen shoulder develops slowly, and in three stages.
Developed by Alex Petruska, DPT and the Massachusetts General Hospital Sports Medicine Service Adapted from: The American Academy of Orthopedic Surgeons, AAOS Online Service, 2003. Rowe,CR, Leffert, RD: "Idiopathic Chronic Adhesive Capsulitis". The Shoulder. Ed.
Freezing Phase The freezing phase is a reactive phase. For patients with an acutely and globally painful shoulder, physical therapy and stretching can cause additional discomfort and stiffening. Resting from painful activities and analgesics may help with pain control.
Frozen Phase In the frozen phase, the shoulder becomes tighter, the pain becomes less and the patient is more comfortable. The patient is encouraged to use the shoulder actively and if comfortable, do gentle stretching exercises.
Thawing Phase In this phase, patients report that the motion of the shoulder is gradually returning. The pain is continuing to decrease. At this time, gentle passive stretching can be increased as long as motion improves and the stretching does not aggravate the pain.
Diagnosis and treatment
The doctor will test the range of motion in your arm and may ask for an X-ray to rule out any
underlying condition. Treatment is geared to relieving the discomfort and restoring motion and function to the shoulder.
Treatment includes: Medications (such as aspirin, alleve or ibuprofen) to reduce the inflammation and relieve the pain.
- Range of motion exercises
- Heat or ice therapies.
- Corticosteroid (cortisone) injections.
- Range of motion exercises, such as those described below, done several times a day.
Developed by Alex Petruska, DPT and the Massachusetts General Hospital Sports Medicine Service Adapted from: The American Academy of Orthopedic Surgeons, AAOS Online Service, 2003. Rowe,CR, Leffert, RD: "Idiopathic Chronic Adhesive Capsulitis". The Shoulder. Ed.
(figure B.), raise the A. involved arm up and then backward (as if to reach overhead) Do 10 repetitions
Wall Climb Stretch Stand facing a wall, place the hand of the affected arm on the wall. Slide the hand up the wall, allowing the hand and arm to go upward. As you are able to stretch the hand and arm higher, you should move your body closer to the wall. Hold the stretch for 15to 20 seconds. Do 10 repetitions.
Internal Rotation: Behind-the-Back Stretch Sitting in a chair or standing, place the hand of the affected arm behind your back at the waistline. Use your opposite hand to help the other hand higher toward the shoulder blade of the opposite shoulder. Do 10 repetitions.
Supine External Rotation with Abduction Lie on your back. Place your hands behind vour head as shown in the top illustration. Slowly lower your elbows to stretch the shoulders toward the surface you are lying on. Do 10 repetitions.
Horizontal Adduction Stretch Lying on your back, hold the elbow of the affected arm with your opposite hand. Gently stretch the, elbow toward the opposite shoulder. Later, this stretch can be done standing. Do 10 repetitions.
Standing Neutral External Rotation Hold a door handle or frame with the hand of the involved arm. While keeping the involved arm firmly against your side and the elbow at a right (90 degree) angle, Rotate your body away from the door to produce outward rotation at the shoulder. Do 10 repetitions.
Developed by Alex Petruska, DPT and the Massachusetts General Hospital Sports Medicine Service Adapted from: The American Academy of Orthopedic Surgeons, AAOS Online Service, 2003. Rowe,CR, Leffert, RD: "Idiopathic Chronic Adhesive Capsulitis". The Shoulder. Ed.
External Rotation in Corner Standing facing a comer, position the arms as illustrated with the elbows at shoulder level. Lean your body gently forward toward the comer until a stretch Is felt. Hold this position gently for15 to 20 seconds. Repeat 10 times.
Internal Rotation Stretch Standing facing a comer, position the arms as illustrated with the elbows at shoulder level. The throwing arm is the one with the hand pointed down. Lean your body gently forward toward a comer until a stretch is felt Hold this position gently for 15 to 20 seconds. Repeat 10 times.
Shoulder Shrugs and Scapular Retraction Shrug shoulders upward as illustrated in figure 1. Pinch shoulder blades backward and together, as illustrated in figure 2.
