FROZEN SHOULDER Often referred to as “Adhesive Capsulitis” and characterized by initially painful and later progressively restricted active and passive glenohumeral (GH) joint range of motion with spontaneous complete or nearly complete recovery over a varied period of time


1. Onset is idiopathic (no attributable reason) :

  • . Often associated with other diseases and conditions such as diabetes mellitus, systemic diseases such as thyroid disease, and Parkinson’s disease

2. Occurs after shoulder injuries or immobilization :

  • post-surgery, post injury (rotator cuff tendon tear, subacromial impingement, biceps tenosynovitis and calcific tendonitis), post stroke. Where post-injury, there may be an altered movement pattern to protect the painful structures, which will in turn change the motor control of the shoulder, reducing the range of motion, and gradually stiffens up the joint.

Sign & symptoms

Acute/ freezing/ painful phase (2 – 9 month) :

  • Gradual onset of shoulder pain at rest
  • Sharp pain at extremes of motion
  • Pain at night with sleep interruption

Adhesive/ frozen/ stiffening phase (4 – 12 months) :

  • Pain starts to subside
  • Progress loss of GH motion in capsular pattern. Main presenting is loss of external rotation (ER) in a dependent position with the arm down by the side

  • Pain is apparent only at extreme movement. Difficulty with grooming, performing overhead activities, dressing, and fastening items behind the back

Resolution/ thawing phase (5 to 24 months) :

  • Spontaneous, progressive improvement in functional range of motion
  • May have persistent symptoms and restriction movement beyond three years

Risk factors Frozen Shoulder

  • Age - Most commonly affects patients between the ages of 40 to 60 years old
  • Gender - It is much more common in women than in men. 70% of people with frozen shoulder are women
  • Shoulder / Arm trauma or surgery - The person with a history of shoulder injury or surgery has an increased risk to develop frozen shoulder. When injury or surgery is followed by prolonged joint immobilization, the risk of developing a frozen shoulder is highest. Immobility of recovery may cause the shoulder capsule to stiffen
  • Having suffered a stroke
  • Other systemic conditions - Several systemic conditions such as heart disease and Parkinson’s disease have also been associated with an increased risk for developing a frozen shoulder
  • Endocrine Disorders - Patients with diabetes are at particular risk for developing a frozen shoulder. Other endocrine abnormalities, such as thyroid problems eg Hyperthyroidism (overactive thyroid) or Hypothyroidism (underactive thyroid) can also lead to development of this condition


Frozen Shoulder treatment

  • hot/cold therapy - Applied to enhance relaxation and reduce pain. It is important to use ice after exercise and after any activity that causes discomfort
  • TENS - Used to relieve the pain. Electric stimulation will helps to improve the blood circulation, thus enhancing the healing process and reducing any swelling or discomfort.
  • Exercise - Stretching and strengthening exercises need to be done regularly. Exercises will restore the movement and maintain the adequate strength and stability of the shoulder joint
  • Patient education :
    • Avoid excessive overhead activities such as throwing
    • Avoid repetitive overhead movements and weight lifting such as military press
    • Always strengthen your shoulders and do not try to play or work through the pain
    • Remember to develop strength of opposing muscle groups of the shoulder
    • Sleep with the arm over or behind your head to prevent shoulder impingement


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  • Symptom-free client confirmation

  • All equipment to be thoroughly sanitized before each session

  • Only fully vaccinated therapists will be assigned to ensure mothers safety with PPEs appliance on duty

  • PPEs change by therapists between appointments

  • Deep cleaning and sanitizing of hands before contact

  • Sheets removal / disposal handling policy

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