Frozen Shoulder (Periarthritis, Adhesive Capsulitis)- Symptoms, Causes, Diagnosis, and Treatment – Physioscare

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Frozen shoulder

Frozen shoulder is defined as a clinical syndrome characterized by painful restriction of both active and passive shoulder movements thanks to causes within the shoulder or remote (other parts of the body).
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Frozen shoulder

First described by Dupley in 1872 and called it as humeroscapular periarthritis. Codman coined the term Frozen shoulder in 1934, and, Neviaser gave the name adhesive capsulitis in 1945.

Epidemiology of Frozen Shoulder
• Incidence generally population is 2 percent.
• Incidence in diabetics is 10-35 percent.
• More common in females than males.
• Mean age is 40-60 years.
• Bilateral 12 percent.


The causes for frozen shoulder could be:
Primary: Here the precise cause isn’t known and it’d be idiopathic.
Secondary: according to Lumberg,  causes could be:

Shoulder causes: Problems directly related to shoulder which can produce to frozen shoulder are tendonitis of structure , bicipital tendinitis, fractures and dislocations around the shoulder, etc.

– Nonshoulder causes: Problems not related to shoulder like diabetes, cardiovascular diseases with pain to the shoulder, which keeps the joint immobile, reflex sympathetic dystrophy, frozen hand shoulder syndrome, a complication of Colles’ fracture, can all cause frozen shoulder. the rationale could be prolonged immobilization of the shoulder because of pain , etc.


• During abduction, and repeated overhead activities of the shoulder, long head of biceps and structure undergo repeated strain. This results in inflammation, fibrosis and consequent thickening of the shoulder capsule, which finishes up in loss of movements. If the movements are continued, then the fibrosis are gradually breaks, and movements return but never come to normal positions.

• Prolonged activity can causes scapular and biceps muscles to waste speedly, and load on joint increases and degenerative changes sets. Capsule is fibrosed and shoulder movements are decreased.

Clinical Features 

A patient with frozen shoulder clinically presents as:
• Decreased range of both active as well as passive shoulder movements.
• The patient demonstrates a capsular pattern of movement restrictions (i.e. external rotation > abduction > internal rotation).
• Pain is noted at the highest stage of stretch.
• Accessory joint play is reduced.
• Resistive tests are generally pain free within the available range of motion.
• Patient is unable to undertake to to routine daily activities like combing the hair, just just in case of women wearing the buttons of their blouse, doing overhead activities, etc.

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Facts you want to kno

Diagnosis of frozen shoulder is primarily by clinical examination which records capsular kind of restriction of both the active and passive range of motion of the shoulder.

Clinical Stages 

There are three classical stages in frozen shoulder:

Stage I (stage of pain): Patient complains of acute pain, decreased movements, external rotation greatest followed by loss of abduction then forward flexion. Internal rotation is least affected. This stage lasts for 10-36 weeks.

Stage II (stage of stiffness): during this stage, pain gradually decreases and therefore the patient complains of stiff shoulder. Slight movements are present. This lasts for 4-12 months.

Stage III (stage of recovery): Patient will haven’t any pain and movements would have recovered but will never be regained to normal. It lasts for six months to 2 years.


In radiology X-ray of the shoulder is  normal; but in few cases, ‘sclerosis’  seen on the fringes of greater tuberosity (Golding’s sign)


Stage I: during this stage, long acting once each day NSAIDs are usually preferred as this condition usually runs an extended course (10-36 weeks). Intra-articular steroids may help to supply transient relief of pain only.

Stage II: during this stage, pain will have decreased considerably, exercises both active also as passive are gradually begun followed by physiotherapy, ultrasound, heat and shoulder wheel exercises. The role of manipulation of the shoulder is controversial but are often attempted under general anesthesia during this stage.

Stage III: during this stage, active and passive exercises, physiotherapy consisting of radio emission diathermy, ultrasound, etc. are continued.

Treatment pearls 

• during this case exercises are best than the modalities, drugs and steroid injection.
• Mobilization techniques are the opposite effective method.
• Traditional manipulation under GA may be a previous successful method.
• Manipulation under GA is more successful compare to traction manipulation.
• Arthroscopic distension : This helps to extend ROM after several weeks or months.
• Arthroscopic releases: this is often indicated in recalcitrant cases where the above measures have all failed.

Exercise Progression for Frozen Shoulder

  • Passive shoulder range of motion exercises
  • Shoulder towel stretches
  • Shoulder active range of motion exercises
  • Isometrics shoulder exercises
  • Scapular stabilization exercises

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