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Physical therapy in the management of frozen shoulder

2017; Medknow; Volume: 58; Issue: 12 Linguagem: Inglês

10.11622/smedj.2017107

2737-5935

HBY Chan, P.Y. Pua, CH How,

Orthopedic Surgery and Rehabilitation

WHAT IS FROZEN SHOULDER?Frozen shoulder, also known as adhesive capsulitis, is defined as "a condition of uncertain aetiology, characterised by significant restriction of both active and passive shoulder motion that occurs in the absence of a known intrinsic shoulder disorder". (1)Patients with frozen shoulder typically experience insidious shoulder stiffness, severe pain that usually worsens at night, and near-complete loss of passive and active external rotation of the shoulder. (2)There are typically no significant findings in the patient's history, clinical examination or radiographic evaluation to explain the loss of motion or pain.Frozen shoulder can be classified as primary or secondary.Primary idiopathic frozen shoulder is often associated with other diseases and conditions, such as diabetes mellitus, and may be the first presentation of a diabetic patient. (3)Patients with systemic diseases such as thyroid diseases (4,5) and Parkinson's disease (6) are at higher risk.Secondary adhesive capsulitis can occur after shoulder injuries or immobilisation (e.g.rotator cuff tendon tear, subacromial impingement, biceps tenosynovitis and calcific tendonitis).These patients develop pain from the shoulder pathology, leading to reduced movement in that shoulder and thus developing frozen shoulder.Frozen shoulder often progresses in three stages: the freezing (painful), frozen (adhesive) and thawing phases (Fig. 1).In the freezing stage, which lasts about 2-9 months, there is a gradual onset of diffuse, severe shoulder pain that typically worsens at night.The pain will begin to subside during the frozen stage with a characteristic progressive loss of glenohumeral flexion, abduction, internal rotation and external rotation.This stage can last for 4-12 months.During the thawing stage, the patient experiences a gradual return of range of motion that takes about 5-26 months to complete. (7,8)Although adhesive capsulitis is often self-limiting, usually resolving in 1-3 years, (9) it can persist, presenting symptoms that are commonly mild; pain is the most common complaint. (10,11)