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

  1. Primary (idiopathic) frozen shoulder
  2. Secondary frozen shoulder
    1. Systemic
      1. Diabetes mellitus
      2. hypothyroidism
      3. hyperthyroidism
      4. Hypoadrenalism
    2. Extrinsic
      1. Cardiopulomonary disease
      2. Cervical disc
      3. CVA
      4. Humerus fractures
      5. Parkinson’s disease
    3. Intrinsic
      1. RTC tendinitis
      2. RTC tears
      3. Biceps tendinitis
      4. Calcific tendinitis
      5. 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

  1. Stage 1: Pre-adhesive stage
  2. Stage 2: Freezing stage
  3. Stage 3: Frozen stage
  4. 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.