Frozen shoulder has been described as a painful condition associated with stiffness and difficulty in sleeping on the affected side. People with this condition have difficulty in dressing, overhead movements and sleep disturbance. It occurs in 2 - 5% of general adult population, 10 - 15% of the people with diabetes. It mainly affects the individuals of 35 - 65 years of age with female predominance. Frozen shoulder is characterized by fibroproliferative tissue fibrosis whereby fibroblasts, producing predominantly type I and type III collagen, transform into myofibroblasts, which is accompanied by inflammation, resulting in shoulder capsular fibrotic contractures and the associated clinical stiffness.
There are two frozen shoulder syndromes, namely primary syndrome and secondary syndrome. In primary or idiopathic syndrome, frozen shoulder that occurs spontaneously or directly without knowing the causative factors. Primary syndrome occurs due to a chronic inflammatory response with fibroblast proliferation which can actually be a response from an abnormal immune system. Secondary syndromes occur due to several triggers such as trauma that can cause shoulder injuries or surgery associated with the onset of other conditions such as diabetes mellitus, autoimmune diseases and cardiovascular disorders.
The clinical presentation of frozen shoulder typically progresses through three stages: the freezing stage, where the shoulder becomes painful and progressively stiff over two to nine months; the frozen stage, characterized by significant stiffness and reduced pain over four to twelve months; and the thawing stage, where gradual improvement in shoulder mobility occurs over five to twenty-four months. The condition can be severely debilitating, impacting daily activities and overall quality of life.
Adhesive capsulitis treatment primarily consists of pain relief and physical therapy techniques. Anti-inflammatory medication is helpful in pain relief, so that mobility interventions can be initiated. Therapeutic modalities include Transcutaneous Electrical Nerve Stimulation (TENS), Interferential Therapy (IFT), Ultrasound, Short Wave Diathermy (SWD) etc, and the physical therapy exercises such as stretching, Codman exercise can be used. Exercises which may be active, passive or active assisted, play a crucial role in the early rehabilitation of these patients.
Age between 40 to 60 years
Stage 2 and 3 Frozen shoulder
Positive capsular pattern
Positive Apley's scratch test
Rotator cuff disease
Post CABG
Post stroke frozen shoulder
Fracture of shoulder
Parallel
Maitland mobilization combined with Stroking release technique
Other interventionMaitland mobilization combined with Stroking release technique of Rotator cuff muscles, along with baseline treatment * Maitland mobilization: * Perform using Grades III and IV glides (anterior, posterior, inferior) targeting the glenohumeral joint. * Aimed at reducing stiffness and improving range of motion. * 3 sets for 30 sec. * Rotator cuff muscle release: (Stroking release technique) * Manual muscle release of supraspinatus, Infraspinatus, Subscapularis and Teres minor for 15 minutes. (2-3 reps per muscle and 1 set per muscle per session) * It will help to reduce muscle tightness and improve mobility 1. Supraspinatus release: The patient will be in sitting or side-lying. Palpate just above the spine of the scapula. Use thumb pressure along muscle fibres. Move from distal end to proximal. 2. Infraspinatus release: The patient will be in a sitting position. Locate the muscle below the spine of the scapula. Apply thumb pressure along muscle fibres or cross friction.
Maitland Mobilization, along with baseline treatment
Other interventionMaitland Mobilization, along with baseline treatment No additional soft tissue work was performed on the rotator cuff muscles. Baseline treatment will be: Hot pack and TENS for 10 minutes Scapular mobilization: Scapular mobilization is performed in a side-lying with the patient relaxed. The therapist passively mobilizes the scapula in different directions to improve scapulothoracic rhythm and reduce stiffness. Techniques used will be: * Scapular elevation, depression * Scapular protraction, retraction 3 sets of 6-8 mobilizations in each direction. 1 session per day and 3 sessions per week (26). Codman exercises: Codman exercises help promote passive motion of the shoulder joint without activating the shoulder musculature, reducing pain and improving mobility. Patient leans forward, hanging the affected arm freely. Small pendulum-like motions are performed in: * Circular motion * Forward back swing * Side-to-side swing 4 sets of 6-8 reps in each direction
Numeric pain rating scale (NPRS)
The Numeric Pain Rating Scale (NPRS) is a widely used tool designed to assess pain intensity in both clinical and research settings. It consists of an 11-point scale ranging from 0 to 10, where 0 represents "no pain" and 10 indicates the "worst imaginable pain." NPRS is a quick and straightforward method, commonly used to track changes in pain over time, particularly in musculoskeletal and postoperative populations
Universal Goniometer
The goniometer is a widely used instrument in clinical and rehabilitation settings to measure joint angles and assess the range of motion (ROM). It helps clinicians monitor progress and identify movement limitations in patients with musculoskeletal conditions.
Shoulder pain and disability index
It is a self-administered questionnaire designed to evaluate pain and functional impairment related to shoulder disorders. It consists of 13 items, divided into pain and disability subscales, and is often used in both clinical practice and research.
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