FROZEN SHOULDER

by :
Yani Christina, M.D

Definition
The

stiffness

and

limitation

in

shoulder movement, both active and

passive,

with

pain

at

the

scapulothoracic joint as well as at the

glenohumeral joint.

Synonim
Adhesive capsulitis
Periarthritis
Pericapsulitis
Stiff shoulder.

The shoulder complex

Etiology
Unknown
Risk factor :
- Trauma
- Diabetes

Pathologic Concepts
1. Adhesions between layers of the

Stages
Stage one

Clinical
Loss/limitation of both active and
passive Shoulder Range of Motion.
Gradual onset of decreased shoulder
function.
Pain can occur when the shoulder
moved or in the end of shoulder
movement.

Differentials Diagnosis
The Rotator cuff tears
Bicipitalis Tendinitis
Tumor of Bone and Soft Tissue

Imaging :
X - Ray
USG
Arthrography

Treatment
1. Medicamentous :
NSAID or Corticosteroid injection.
2. Rehabilitation :
Restoring passive and active range of motion.
* Modality

: heat therapy.

* Home program : Stretches in all range of

motion.
3.

Surgical

Data base identity ( 14/10/09 )

Name
: Mrs. PWT
Sex
: Female
Age
: 66 y.o.
Address
: Surabaya
Occupational
: Housewife
Religion
: Moslem
Marital status
: Married
Referred from Geriatric Out-patient Clinic
with Osteoporotik shoulder D

Chief complaint: nyeri bahu kanan

History of present illness :
Pain at right shoulder since 3 years ago.
Pain such as dull pain. Pain felt especially
after she washed clothes and when she
moves her arm to the back to wear
clothes. Pain was relieved when she take
a rest.
She still can cooking.
Pain is not radiating. There are no
numbness and tingling sensation.

History of past illness :

Diabetes Mellitus and Hypertension
known since 5 years ago, regularly
controlled (every month) at Geriatric
Outpatient clinic.
No history of trauma
History of medication :
Glucodex
2-1-0
Metformin 0-0-2
Adalat oros 1-0-0
Meloxicam 2 x 1

General Status
CM, ambulatory independent, gait N, right handed
Body Weight : 55 Kg, Body height : 152 cm, BMI =
23,8
BP : 120/80 mmHg, HR : 80 x/minute, RR : 20
x/minute
Head and Neck : No Anemia, Icterus, Cyanosis,
Dyspneu
Thorax
: Cor
: S1S2 sound, murmur -,
gallops Pulmo : vesicular/vesicular,
wheezing -/-, ronchi -/Abdomen
: Meteorismus Liver / Spleen : unpalpable

Physiatric Examination
Musculoskeletal examination
Cervical
ROM
MMT
Flexion
F (0-450)
5
Extension
F (0-450)
5
Lateral Flexion
F/F (0-450)
5/5
Rotation
F/F (0-600)
5/5
Trunk
ROM
MMT
Flexion
F (0-800)
5
Extension
F (0-300)
5
Lateral Flexion
F/F (0-350)
5/5
Rotation
F/F (0-450)
5/5

Shoulder

ROM

MMT

Flexion Active 0-1400 /F (0-1800) 5-/5

Passive 0-1600
Extension Active
0-400 /F (0-600)
5-/5
Passive 0-500
Abduction Active 0-1400/F (0-1800) 5-/5
Passive 0-1500
Adduction Active
F/F (0-450)
5/5
Ext. Rot. Active 0-500/F (0-900)
5-/5
Passive 0-600
Int. Rot. Active 0-600/F (0-700)
5-/5
Passive 0-700

Elbow
ROM
MMT
Extension-Flexion F/F (0-1500)
Forearm supination F/F (0-800)
Forearm pronation

F/F (0-800)

5/5
5/5
5/5

Wrist
ROM
MMT
Flexion
F/F (0-800)
5/5
Extension
F/F (0-700)
5/5
Radial deviation
F/F (0-200)
5/5
Ulnar deviation F/F (0-300)
5/5

Fingers
Flexion
MCP
PIP
DIP
Extension
Abduction
Adduction
Thumb
Flexion
MCP
IP
Extension
Abduction
Adduction
Opposition

ROM

MMT

F/F (0-900)
5/5
F/F (0-1000)
5/5
F/F (0-900)
5/5
F/F (0-300)
5/5
F/F (0-200)
5/5
F/F (200-0)
5/5
ROM
MMT
F/F (0-900)
5/5
F/F (0-800)
5/5
F/F (0-300)
5/5
F/F (0-700)
5/5
F/F (500-0)
5/5
5/5

Hip
ROM
MMT
Flexion
F/F (0-1200)
5/5
Extension
F/F (0-300)
5/5
Abduction
F/F (0-450)
5/5
Adduction
F/F (0-200)
5/5
Ext. Rotation F/F (0-450)
5/5
Int. Rotation
F/F (0-450)
5/5
Knee
ROM
MMT
Extension-Flexion F/F (0-1350) 5/5
Ankle
ROM
MMT
Plantar Flexion
F/F (0-500)
5/5
Dorsi Flexion
F/F (0-200)
5/5
Inversion
F/F (0-350)
5/5
Eversion
F/F (0-150)
5/5

Toes
ROM
MMT
Flexion
MTP
F/F (0-300)
5/5
IP
F/F (0-500)
5/5
Extension
F/F (0-800)
5/5
Big Toe
ROM
MMT
Flexion
MTP
F/F (0-250)
5/5
IP
F/F (0-250)
5/5
Extension
F/F (0-800)
5/5

Neurological Examination
N. Cranialis I XII

Peripheral N. VII palsy

Physiological Reflex :
TPR
KPR

BPR

+2/+2

+2/+2

+2/+2
APR

+2/+2

Pathological Reflex :
Sensory deficit

Babinski -/-, HT -/-/-

Locally status Regio Shoulder D/S

I : Redness -/-

Swelling -/-

Deformity -/P : spasme upper trapezius muscle +/+

Special Examination :
Compression

: -/-

Distraction

: -/-

TOS I, II, III

: -/-, -/-, -/-

Drop Arm Test

: -/-

Yergason Test

: -/-

Appley Scratch Test :

- Abduction & External Rotation : F/Occipital
- Adduction & Internal Rotation : F/VL V

Laboratory studies
Glucose fasting : 107 (13/10/09)
X-ray right shoulder : (15/09/09)
Foto tak tampak kelainan,
osteoporotik

Diagnosis

: Frozen Shoulder Dextra

Functional diagnosis :
Impairment

: Stiffness Shoulder Dextra

Disability

: Problem in ADL (wearing

clothes)
Handicap

Problem list

1. Surgical
:2. Medical
: Frozen Shoulder Dextra + DM
+ HT
3. Rehabilitation Medicine:
R1 (Ambulation) : R2 (ADL)
:difficulty in wearing clothes
R3 (Communication) : R4 (Sociological)
:R5 (Psychological) : R6 (Vocational) : R7 (Others)
: - Pain in right shoulder
(VAS=4)
- ROM Limitation of

Planning :
1. Surgical : 2. Medical : continue the medication from
Geriatric
Department
3. Rehabilitation Medicine :
P. Dx : P. Tx :
a. Modality : USD Shoulder D frek 1 MHz, 2
W/cm2
for 10 minutes
b. Gymnasium : Stretching right shoulder
with :
- Finger Ladder
- Over Head Pulley

P. Mx : Clinical
P. Ed : Health Education & Home Exercise Program
- Towel Exercise
- Wall Climbing Exercise
- Active Pendular Glenohumeral Exercise
- Post Pandrial Exercise

Summar
y It has been reported that a patient, 66 y.o. female,
referred from Geriatric Out-patient Clinic with Osteoporotik
Shoulder D. Chief complain was nyeri bahu kanan.
Pain at right shoulder since 3 years ago. Pain such as
dull pain. Pain felt especially after she washed clothes and
when she moves her arm to the back to wear clothes. Pain
was relieved when she take a rest. She still can cooking.
Pain is not radiating. There are no numbness and tingling
sensation.

On physical examination, there were limitation of ROM

right shoulder and pain in shoulder movement. Limitation
for right Appleys Scratch Test. Diagnose Frozen Shoulder
Dextra.
Planning Therapy are USD area right shoulder and
stretching right shoulder with Finger Ladder and Over
Head Pulley. Planning Monitoring are clinically and VAS.
Planning Education for Health Education & Home Exercise
Program are Towel Exercise, Wall Climbing Exercise,
Active Pendular Glenohumeral Exercise and Post Pandrial
Exercise.

Planning Therapy are USD area right shoulder,

stretching right shoulder, Finger ladder and Over
Head Pulley. Planning Monitoring are clinically and
VAS. Planning Education for Health Education &
Home Exercise Program are Towel Exercise, Wall
Climbing Exercise, Active Pendular Glenohumeral
Exercise and Post Pandrial Exercise

Thank you very

much

Active Pendular
Glenohumeral Exercise

Towel
Exercise