Physical therapy in the management of frozen shoulder

Abstract

Frozen shoulder, also known as adhesive capsulitis, is a common presentation in the primary care setting and can be significantly painful and disabling. The condition progresses in three stages: freezing (painful), frozen (adhesive) and thawing, and is often self-limiting. Common conservative treatments include nonsteroidal anti-inflammatory drugs, oral glucocorticoids, intra-articular glucocorticoid injections and/or physical therapy. However, many physicians may find themselves limited to prescribing medications for treatment. This article elaborates on physical therapy exercises targeted at adhesive capsulitis, which can be used in combination with common analgesics.

Keywords: adhesive capsulitis; frozen shoulder; physical therapy; self-management.

Fig. 1

Chart shows the clinical presentation of frozen shoulder. Icons with facial expressions represent the level of pain of the patient.

Fig. 2

Photographs show examples of stretching exercises: (a) active assisted shoulder forward flexion with wand; (b) active assisted shoulder external rotation with wand; and (c & d) pendulum exercise.

Fig. 3

Photographs show examples of strengthening exercises: (a) scapular retraction; (b) posterior capsule stretch; and (c) isometric shoulder external rotation. In scapular retraction, the scapulae are pulled towards each other (arrows in a).