Frozen Shoulder Syndrome

berold Physiotherapy Comments Off on Frozen Shoulder Syndrome - Please Allow Images
North Shore Orthopoedic - Allow/Download Image to viewSevere shoulder pain characterized by capsular contraction, formation of adhesions & movement loss.
The shoulder is comprised of:

• Humerus,
• Clavicle &
• Scapula

Usually frozen shoulder occurs due to pain & secondary immobility, “don’t use it, you lose it.”

1. Pain may be due to shoulder injury, sub-acromial bursitis, impingement, etc.,
2. Surgery: immobilization following surgery.
3. Anatomical: bursitis is secondary to positional or structural-like phenomenon,
i.e. simply due to its’ anatomical location
4. Neurogenic: the nerve supply, if impeded, interrupts neuromuscular function,
producing muscle weakening / associated pain
5. Other: falling, lifting, repeated micro-trauma, age-related cuff degeneration &
6. Idiopathic: no apparent cause. The shoulder suddenly, without warning,
becomes painful & the capsule surrounding the shoulder tautens

North Shore Orthopoedic - Allow/Download Image to view• Pain: gradual or sudden onset of shoulder pain.
• Night: pain 2ndary to sleeping on the affected shoulder.
• Swelling: swollen tendons & increased upper arm circumference
• Palpation: painful to palpate the tissues surrounding the humerus & scapula
• Alignment: the scapula is misaligned with accompanying humeral head forward
tilting & a reversal of scapula-humeral rhythm
• Active R.O.M.: movement in all planes of motion is incredibly stiff & painful.
• Passive R.O.M.: movement initiated by the clinician is virtually impossible
• Strength: weakness proportional to pain severity, though injury may not have
precipitated thesymptoms
• Occupational: cannot work due to pain
1. Mechanical: Overhead movement “pinches” the tendon & bursa against the
over-hanging acromion causing
1.1 If the scapula is tightly bound against the rib cage, reversal of the scapula-humeral
rhythm occurs & the shoulder
muscles strain moving the scapula
2. Anatomical: Structural abnormalities result in a narrower sub-acromial space,
eg. A-C joint arthritis & spurs under the
acromion narrow the sub acromial space
3. Computer Posture: computer-related position predisposes the shoulder to
misalignment, muscle imbalance & loss of
antagonist muscle programming
4. Muscle Imbalance: characterized by interruption of the length / tension ratio
4.1 Training Errors: over-training in 1 plane of motion, inadequate recovery time,
overhead training with too much load
4.2 Overuse Position: Day-to-day computer-related positioning poses difficulties due
to occupational-induced muscle imbalance & weakness.
5. Other: falls, lifting, repeated micro-trauma, age-related cuff degenerationNorth Shore Orthopoedic - Allow/Download Image to view
6. Idiopathic: some frozen shoulders occur spontaneously without
clear rationale
7. Demographics: women age 45+ more frequently suffer “frozen” shoulder syndrome.
The writer hypothesizes this may be secondary to strangling of the micro-circulation due to the brassiere.
Frozen shoulder injuries always take longer because the tendon is not the “working” component of the unit & effective circulation is directed to the muscle belly.1. Physician’s Exam: indications for NSAID’s & investigative testingNorth Shore Orthopoedic - Allow/Download Image to view
2. P.R.I.C.E.:
b. Rest: relative rest, pain-free R.O.M. & avoid overhead motions
c. Ice: ice for 15 minutes every 2 – 3 hours to reduce inflammation
d. Elevate / Exercise: strategic exercise to restore passive & then active R.O.M.
e. Compression: N/A
f. Elevate / Exercise: following appropriate rest, strategic exercise to restore
passive &then active, pain-free R.O.M.
3.Physiotherapy: ultrasound & laser enhances micro-circulation, acupuncture
4. Manual therapy: re-aligns the scapula & restores scapula-humeral rhythm
5. Targeted Stretching:Timing is critical because pre-mature stretching
exacerbates pain.
5.1 Lengthening the muscles surrounding the shoulder joint, enhances
scapulo-humeral rhythm, increases the subacromial
restores length / tension ratios & prevents adhesive capsulitis
6. Exercises: avoid cyclical pain patterns as this encourages “guarding.”
6.1 Improve muscle control: Shoulder stability exercises involve precise
re-training of scapular movement, practiced
with minimal resistance
6.2 Re-program Scapula control: scapular depression & retraction
6.3 Rotator Cuff Muscle Balance: require minimal weight to correct imbalances
• Assisted R.O.M.: creep the hand up the wall, door-frame pulley
• Free-Active: strengthen scapular & rotator cuff muscles with minimal weight
• Isometrics: neutral & 30 degrees of amplitude
• Isotonic: free weights & pulleys
• Dynamic: theraband resisted rotation
7.Functional: incorporate speed & load specific for functional recovery.
Eg. proprioception exercises, wall push ups
8.Posture: head & shoulder alignment optimizes muscle length tension relationships, reducing impingement
This is directed by pain, not the time since pain began. You must have:

• Full & pain-free shoulder R.O.M

• Restored length / tension ratios, full strength & coordinated scapula control

• Optimizing the sub-acromial space to prevent impingement & potential “freezing.”

• Correct warm-up & shoulder stretching techniques

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