Increasemaintain shoulder range of motion conservative treatment o symptoms typically resolve on their own, regardless of treatment or no treatment. Department of rehabilitation services physical therapy. Significant improvements in selfreported pain, disability, shoulder rom, and strength were reported following treatment. Frozen shoulder description frozen shoulder adhesive capsulitis is a disorder characterized by pain and loss of motion or stiffness in the shoulder. The intent of this protocol is to provide the clinician with a guideline of the postoperative rehabilitation course of a patient that has undergone a total shoulder arthroplasty tsa or hemiarthroplasty humeral head replacement, hhr.
Each period can last 46 months, with the total course lasting 1224 months. A manual therapy and home stretching program in patients with. Talk to your doctor or physical therapist about which exercises will best help you meet your rehabilitation goals. Secondary frozen shoulder develops due to some disease process, which can further be classified as systemic, extrinsic, or intrinsic.
Talk to your doctor or physical therapist if you have any pain while exercising. Frozen shoulder often responds extremely well to manual therapy treatment. Review videos for passive rom codmans pendulum, passive flexion, stickassisted flexion, stickassisted extension, stickassisted abduction, stickassisted external rotation, stickassisted internal rotation, active rom, overhead pulley, stretching supine. In this event, the driving surgery should take precedence over the other.
Additionally, when relevant articles were identified, their reference lists were hand searched in an attempt to identify other relevant articles. Frozen shoulder is a disorder in which the connective tissue surrounding the shoulder. Adhesive capsulitis, also known as frozen shoulder, is a condition associated with shoulder pain and stiffness. Physical therapy for frozen shoulder typically involves using therapeutic modalities and procedures to decrease your pain, and aggressive range of motion rom exercises to help improve your shoulder s mobility.
There is no intervention more effective than therapeutic exercise for painful shoulder conditions. Sometimes multiple simultaneous procedures are performed on the shoulder. The joint capsule contains the ligaments that attach the. Frozen shoulder page 4 frozen shoulder it is important to realise that although the pain and stiffness can be very severe, usually the problem does resolve. Several treatment options are available to address frozen shoulder. Frozen shoulder usually affects patients aged 4070, with females affected more than males, and. This inflammatory condition that causes fibrosis of the glenohumeral joint. The following protocols are in pdf format which requires. Stand and lean over slightly, allowing the affected arm to hang down. This is a booklength tutorial covering every aspect of frozen shoulder for both professionals and patients. Frozen shoulder physical therapy protocol musculoskeletal. Range of motion exercises, such as those described below, done several times a day. Shoulder accelerated rehabilitation protocol sharp.
Physical therapy in the management of frozen shoulder smj. There is a large amount of variability with recovery between patients. Frozen shoulder page 6 frozen shoulder support problem arm with other hand at wrist and lift it up overhead do not let your back arch can start with elbows bent repeat 510 times 3. Physical therapy is one of the most important tools to help improve shoulder rom in the frozen shoulder. Contact ohio state sports medicine physical therapy at 6142932385 if questions arise. Frozen shoulderadhesive capsulitis tips and exercises. Other treatments done for frozen shoulder also include heat. People with frozen shoulder usually experience an initial period characterized by an achy shoulder at rest, severe pain with movement, and difficulty sleeping because of shoulder pain. Adhesive capsulitisfrozen shoulder clinical practice guideline progression is time and criterionbased, dependent on soft tissue healing, patient demographics, and clinician evaluation. Frozen shoulder exercises aim to reduce pain, increase extensibility of the capsule, and improve strength of the rotator cuff muscles restorative programme. Frozen shoulder also known as adhesive capsulitis is a condition in which the shoulder is stiff, painful, and has limited motion in all directions. Nevertheless, it is imperative to consider the patients. The shoulder is a wonderfully complex joint that is made up of the ball and socket connection between the humerus ball and the glenoid portion of the scapula socket. Shoulder arthroscopic capsular release rehabilitation phase two.
Frozen shoulder occurs when the strong connective tissue surrounding the. A manual therapy and home stretching program in patients. Frozen shoulder is the temporary loss of normal range of motion in the shoulder. It usually involves pain and stiffness that develops gradually, gets worse and then finally goes away.
To restore motion, physical therapy is often ordered. How do we treat frozen shoulder with manual therapy. In performing the following frozen shoulder exercises, stretch to the point of tension but not pain. Finally, this condition usually affectsthe shoulder which is. Frozen shoulder, also called adhesive capsulitis, is a painful condition in which the movement of the shoulder becomes limited. The causes of frozen shoulder are not fully understood. Many physical therapy and home exercises can be used as a first line treatment for. Many physical therapy and home exercises can be used as a firstline treatment for adhesive capsulitis.
Grasp the end of the rod with hand 1 and the middle of the rod with hand 2. Frozen shoulder symptoms, causes, diagnosis, treatment. Kavanagh, pac this protocol provides general guidelines for initial stage and progression of rehabilitation. The final stage is the resolution or thawing phase. Ideally, only patients with loss of active and passive external rotation of the involved shoulder with a normal xray would be. Frozen shoulder is a disorder in which the connective tissue surrounding the shoulder becomes inflamed and stiff, restricting motion and causing pain. Once stiffness is more of a problem than pain, physiotherapy is indicated. The physical therapy for primary idiopathic frozen shoulder described herein can be useful for prescribing home exercises to increase shoulder mobility. Strengthening the muscles that support your shoulder will help keep your shoulder joint stable. Systemic secondary frozen shoulder develops due to underlying systemic connective tissue disease. Total shoulder arthroplasty hemiarthroplasty protocol.
Nonsurgical shoulder impingement rehabilitation protocol ramin r. Depending on how long it has been present, it might require many months of treatment, but it often fully or nearly fully resolves with regular care. For patients with an acutely and globally painful shoulder, physical therapy and stretching can cause additional discomfort and stiffening. Sheridan et al 2006 while frozen shoulder is commonly missed or confused with a rotator cuff injury, it has a distinct pattern of symptoms. Frozen shoulder most commonly affects people between the ages of 40 and 60, and occurs in women more often than men.
It occurs in about 2% to 5% of the population and commonly presents in 40 to 60yearolds. Levine and colleagues 20 showed a 90% success rate with nonoperative treatment oral nsaids and standardized physical therapy over an average of 4 months. Depending on how long it has been present, it might require many months of. Sling allowed as needed for comfort only, first 5 7 days, taking arm out often 5 7 times a day for elbow rom. Review videos for passive rom codmans pendulum, passive flexion, stick. Kelley, dpt academy of orthopaedic physical therapy. Physical therapy and supervised home exercises are. Pdf home based exercise program for frozen shoulder follow. The intent of this protocol is to provide the clinician with a guideline of the postoperative rehabilitation course of a patient that has undergone a. It is not intended to be a substitute for appropriate. Freezing phase the freezing phase is a reactive phase.
Frozen shoulder usually affects patients aged 4070, with. Pdf management of the frozen shoulder researchgate. Current therapy 1999 apr, 40 4 jingian yang, cheinwei chang, et al, mobilization techniques in subjects with frozen. Nevertheless, it is imperative to consider the patients symptoms and stage of the condition when selecting a physical treatment method for frozen shoulder. Physical therapy in the management of frozen shoulder ncbi. Manual therapy has been demonstrated to reduce pain and improve function in patients with frozen shoulder contracture syndrome fscs, but no evidence exists to support one form of manual. Any forceful pushing, pulling or lifting activities should continue to be avoided.
Chronic idiopathic adhesive capsulitis is a condition of the shoulder with. A thorough evaluation will help define the right treatment approach for your shoulder. Physical therapy in the management of frozen shoulder singapore. For patients who are recovering from shoulder surgery, please refer to the following protocols as advised by your physical therapist. Frozen shoulder description frozen shoulder adhesive capsulitis is a disorder characterized by pain and loss of motion or stiffness in the. Adhesive capsulitis also termed frozen shoulder is commonly treated by manual therapy and exercise, usually delivered together as components of a physical therapy intervention. The shoulder is a wonderfully complex joint that is made up of the ball and socket connection between the humerus ball and the. I ice you should rest from all activities that cause shoulder pain. Nevertheless, women are moresusceptible to frozen shoulder, as well as people suffering fromdiabetes, hyperthyroidism and parkinsons disease. Additionally, when relevant articles were identified, their reference lists were hand searched in an attempt to identify. Physical therapy, with a focus on shoulder flexibility, is the primary treatment recommendation for frozen shoulder. Frozen shoulder is a condition that affects your shoulder joint.
Frozen shoulder adhesive capsulitis center for sports medicine. Department of rehabilitation services reverse total. Frozen shoulder adhesive capsulitis orthoinfo aaos. For patients with an acutely and globally painful shoulder, physical therapy and stretchmg can cause additional discomfort and stiffening. Swing the arm in a small circle about a foot in diameter. This standard of care is designed to assist in the physical therapy management of the patient with shoulder adhesive capsulitis. Frozen shoulder develops slowly, and in three stages. Additionally, 4 of 11 patients showed pain improvements that exceeded the minimal clinically important difference mcid on the visual analog scale postintervention, and 8 of 11 showed pain improvements at 6 and 9 months. For patients with an acutely and globally painful shoulder, physical therapy and stretchmg can.
There is a loss of the ability to move the shoulder, both voluntarily and by others, in multiple. Primary frozen shoulder is idiopathic in nature, and radiographs appear normal. Pdf home based exercise program for frozen shoulder. Massage treatments done regularly can help in alleviating the shoulder pain and loosening or relaxing the stiff shoulder muscles. Frozen shoulder is reported to affect 2% to 5% of the general population,4,64,88 increasing to 10% to 38% in patients with diabetes and thyroid disease. Resting from painful activit1es and analgesics may help with pain control. The socket portion of the joint is not naturally deep. Manual therapy and exercise for adhesive capsulitis frozen. It tends to get worse, and can lead to considerable disability. This stage is characterized by a slow recovery of motion. Frozen shoulder academy of orthopaedic physical therapy. The normal course of frozen shoulder is periods of freezing, then frozen, and then thawing. This leads to a progressive loss of motion freezing and limited function of the shoulder over several months, a time when there is often less pain but.
After 72 hours, ice the shoulder after activity or exercise. Frozen shoulder occurs when the strong connective tissue surrounding the shoulder joint called the shoulder joint capsule become thick, stiff, and inflamed. These guidelines were issued in 20, based on publications in the scientific literature prior to september 2011. It is more common in women between the ages of 40 years to 70 years old. It affects about two percent of the general population. Finally, this condition usually affectsthe shoulder which is less active, even though in every 5thsufferer the condition spreads onto the other shoulder too. Frozen shoulder or adhesive capsulitis is a common source of shoulder pain. Jan 28, 2015 you may benefit from the skilled services of a physical therapist if you have a frozen shoulder. Rotator cuff and shoulder conditioning program introduction 1 additional notes. In addition to education on the condition, your physical therapist will help determine the right combination of stretching and mobility exercises and joint mobiliza. Sling allowed as needed for comfort only, first 5 7 days, taking arm out often 5. Shoulder arthroscopic capsular release rehabilitation. This operation is not done routinely for frozen shoulder, only for those which are very slow to resolve.
Use of the operated arm you may now safely use the arm for most normal daily activities. Please keep in mind the driving surgical intervention. The condition typically affects adults over age 40, and women more often than men. Here are some videos explaining shoulder and arm exercises which you may find useful.
The intent of this protocol is to provide the physical therapist with a guidelinetreatment protocol for the postoperative rehabilitation management for a. Adhesive capsulitis ac, often referred to as frozen shoulder is characterized by initially painful and later progressively restricted active and passive glenohumeral joint range of motion with spontaneous complete or nearcomplete recovery over a varied period of time. In addition, people with diabetes are at an increased risk for developing frozen shoulder. Keeping these muscles strong can relieve shoulder pain and prevent further injury. The condition typically affects adults over age 40, and women. Aggressive treatment with physical therapy frozen shoulder exercises, closed manipulation or surgical release may accelerate recovery, moving the patient from the frozen stage into the thawing phase. Diagnosis is based on clinical examination and medical history and a key alerting feature is restriction of shoulder movement in all directions. Please only do these exercises if you have been advised to do so by. Dynamic splinting was also recently evaluated in patients with stage 2 frozen stage adhesive capsulitis. It is important to perform therapy in the painfree zone, during stage 2.