Background
- Mostly unknown etiology
- Incidence in general population between 2.3-5%; 10.8-19% in the diabetic population (Pal et al 1986; Bridgman 1972)
- More females affected than males (Lundberg 1969; Binder 1984)
- Pathology consists of a proliferative hypervascular synovitis resulting in fibrosis or contracture to the capsule and ligaments
Classification
- Primary (idiopathic) frozen shoulder
- Secondary frozen shoulder
- Systemic
- Diabetes mellitus
- hypothyroidism
- hyperthyroidism
- Hypoadrenalism
- Extrinsic
- Cardiopulomonary disease
- Cervical disc
- CVA
- Humerus fractures
- Parkinson's disease
- Intrinsic
- RTC tendinitis
- RTC tears
- Biceps tendinitis
- Calcific tendinitis
- AC arthritis
*From Coumo, F. Diagnosis, Classification, and Management of the Stiff Shoulder. In: Disorders of the Shoulder: Diagnosis and Management. Iannotti, JP and Williams GR (eds). 1999
Stages
- Stage 1: Pre-adhesive stage
- Stage 2: Freezing stage
- Stage 3: Frozen stage
- Stage 4: Thawing stage
Physical Therapy Interventions
Joint Mobilizations
- Yang et al (2007) compared the use of 3 mobilization techniques - end-range mobilization (ERM), mid-range mobilization (MRM), and mobilization with movement (MWM) - in the management of 28 subjects with frozen shoulder syndrome. ERM and MWM were more effective than MRM in increasing mobility and functional ability.
- Bulgen et al (1984) performed a randomized controlled trial comparing passive mobilization techniques (3 times per week for 6 weeks, intensity unknown) with intra-articular steroid injections, ice therapy followed by PNF, or no therapy; few long-term (6 months) advantages of any of the treatment regimens over no treatment were seen.