Physiotherapy & Physical Rehabilitation

Frozen shoulder (FS) is an insidious, painful condition that results in a gradual restriction of movements. The primary pathologic change in IAC is inflammation, and the fibrosis reaction is a secondary reaction, leading to thickening, contracture, and adherence of the capsule and synovia as well as the surrounding ligamentous structures. Many patients continue to have a significant long term painful restriction in their range of motion, although few are functionally restricted. The normal course of FS has been described as having 4 stages: preadhesive, freezing, frozen, and thawing. The diagnosis of FS is based on a thorough history taking and physical examination. Radiographs of the shoulder are usually negative. Imaging studies including arthrography, ultrasonography, and magnetic resonance imaging can be used to rule out concomitant conditions that may affect the treatment and to confirm FS. The goals of treatment are to relieve pain, to restore restore func¬tion and motion of the shoulder, and improve quality of life. Treatments for FS range from con¬servative treatments including physical therapy, therapeutic exercise, joint mobilization and manipulation, nonsteroidal anti-inflammatory and opioid medications, intra-articular steroid and hyaluronic acid injections, suprascapular nerve block, glenohumeral distention ar¬thrography with and without steroid supplementation, and manipulation under general anesthesia to surgical intervention. Clinically effective joint mobilization and manipulation improves tissue extensibility, reduces soft tissue swelling and inflammation, reduces pain, increases range of mo¬tion, and stimulates peripheral mechanorecep¬tors in FS. It is necessary to refine the selection of treatment for individual patients according to the phase of the disease.