A 48-year-old female presents with progressive shoulder pain and stiffness for the past four months. She reports difficulty combing her hair, reaching overhead, and sleeping on the affected side. There is no history of trauma.
This presentation is typical of adhesive capsulitis, commonly known as frozen shoulder.
Understanding Frozen Shoulder
Frozen shoulder is characterized by gradual onset of pain followed by progressive restriction of both active and passive shoulder movements. It often affects individuals between 40–60 years and may be associated with diabetes or prolonged immobilization.
The condition progresses through three stages:
- Freezing stage
- Frozen stage
- Thawing stage
Each stage requires different rehabilitation focus.
Step 1: Subjective Assessment
Key points to assess:
- Duration and progression of symptoms
- Pain severity and night pain
- Functional limitations
- History of diabetes or thyroid disorders
- Previous shoulder injuries
Night pain and gradual stiffness are hallmark signs.
Step 2: Objective Assessment
Observation
- Guarded shoulder posture
- Reduced arm swing
Range of Motion
Global restriction, especially in:
- External rotation
- Abduction
- Flexion
Both active and passive movements are limited.
End Feel
Capsular pattern with firm end feel.
Stage-Based Rehabilitation
Stage 1: Freezing Stage (Pain Dominant)
Goals:
- Pain control
- Gentle mobility
- Prevent further stiffness
Interventions:
- Gentle pendulum exercises
- Pain-free active-assisted movements
- Patient education
Aggressive stretching should be avoided.
Stage 2: Frozen Stage (Stiffness Dominant)
Goals:
- Improve mobility
- Reduce stiffness
Interventions:
- Joint mobilization techniques
- Stretching exercises
- Capsular mobility drills
- Scapular strengthening
Progression should be gradual.
Stage 3: Thawing Stage (Recovery Phase)
Goals:
- Restore full range
- Strengthen shoulder muscles
- Improve functional movement
Interventions:
- Progressive resistance training
- Functional task training
- Postural correction
Recovery may take several months.
Role of Patient Education
Patients must understand that frozen shoulder is typically self-limiting but prolonged. Setting realistic expectations improves compliance and reduces frustration.
When to Refer?
Referral may be needed if:
- Severe pain persists
- No progress after prolonged therapy
- Suspected underlying pathology
Medical options may include corticosteroid injections or surgical release in resistant cases.
Clinical Reasoning Summary
Key features of frozen shoulder:
- Gradual onset
- Global ROM restriction
- Capsular pattern
- Stage-based progression
Physiotherapy focuses on pain control, mobility restoration, and functional strengthening.
Conclusion
Physiotherapy management of frozen shoulder requires structured assessment and stage-specific intervention. With consistent rehabilitation and patient education, most individuals regain functional movement over time.
Early physiotherapy reduces stiffness severity and improves long-term outcomes.