Frozen...

Journal Pain Management in
Frozen Shoulder
Dianita Ariani
17710030
Abstract
Frozen shoulder has often frustated both
orthopedic surgeons and patients.
Frozen shoulder is a common disease which
causes significant morbidity.
No clear cause has yet been found for
idiophatic type of frozen shoulder.
Introduction
The first recorded description of a frozen shoulder was
reported by Duplay in 1872 in his description of a
periarthritis scapulohumeral, though the term frozen
shoulder was first used in 1934 by Codman, who
described the common features of a slow onset of pain
felt near the insertion of the deltoid muscle, inability to
sleep on the affected side, and restriction in both active
and passive elevation and external rotation, yet with a
normal radiological appearance.
A stiff and painful shoulder is often casually labelled as a
frozen shoulder.
Epidemiology
Female 40 Years
Male 40 Years
Pathology
Aetiology
Idiopatic
Secondary
Tabel 1: condition that can lead to secondary frozen shoulder

Frozen Shoulder Stage
Explanation
3 stage of frozen shoulder progression:
Painful stage: shoulder pain starts gradually and
progressively worsens
Frozen stage: pain may reduce in this stage,
although shoulder stiffnes and restriction increase.
Shoulder ROM is dramatically reduce.
Thawing stage: ROM wil; gradually increase and
the shoulder will be more responsive to stretching
exercises and treatment.
Clinical picture
Clinical Picture
Shoulder pain with slow onset
Pain felt at deltoid insertion
Inability to sleep on affected side
Athropy of the supra and infraspinatus muscles
Sometimes minimal local tenderness
Restriction of active and passive ROM
Painful and restricted: elevation and external
rotation.
History
Night and rest pain are common in the early stage.
Other condition that have shown an association with frozen
shoulder are Hyperthyroidism, Hypothyroidism,
Hypoadrenalism, Parkinsons disease, Cardiac disease and
history of sroke.
A history of cardiac surgery and neurosurgery.
There are two classifications:
1.Primary Frozen Shoulder. This occurs without an identifiable
cause.
2.Secondary Frozen Shoulder. This occurs as a result of injury,
surgery, or illness.
Special examination
Plain x-ray: often these might be reported as normal but
some may show periarticular osteopenia, exluding other
causes such glenohumeral arthritis, calcific tendonitis or
rotator cuff disease.
MRI helpful in identifying other causes of stiff shoulder, such

as infection or tumors.
Laboratory helpful in patients with lead to secondary frozen

shoulder include TSH, fasting blood glucose and lipid level.
Treatment
Non Surgical
Medication: NSAID, ibuprofen, aspirin
Steroid intraarticular
Physioteraphy: Stretching, physical therapy
Surgical
Manipulation Under anesthesia
Physical Therapy
Explanation
I. Pendulum: repeated 5-10 times
2. Twisting outward: sit and holding rolling pin or umbrella,
body cant swing. Repeated 5-10 times.
3. Arm overhead: lying on your back. Arm with other hand at
wrist and lift up overhead.
4. Arm overhead/twisting outward: place hands behind neck
or head. Repeated 5-10 times.
5. Kneelling on all fours: repeated 5-10 times.
6. Stretching shoulder: take hand of your problem shoulder
across body towards opposite shoulder. Repeated 5 times,
holding for 20 seconds.
Shoulder Manipulation
Explanation
Manual manipulation of the affected shoulder should be performed

by a skilled manual practitioner. The goal of the manipulation is to
manually break free restrictive adhesions and to restore motion.
Manipulation bears the risk of tearing the shoulder joint capsule or
causing a disruption of internal structures. Chiropractic
The patient can expect the practitioner (typically a chiropractor or

osteopath) to manually move the shoulder in a manner that will
open the joint and place tension on the adhesions and contractures.
Sometimes quick impulses are utilized to mobilize the restrictions.
Myofascial Mobilization
.
Explanation
Soft tissue manipulation of the shoulder,
frequently called myofascial release or soft
tissue mobilization, is used to free adhesions
that limit motion and create pain. Myofascial
release is typically a slow stretching of soft
tissues that is performed while applying a
sustained pressure to connective tissue of the
involved structures
Manipulation Under Anesthesia
(Orthopedic manipulation of shoulder under sedation)
Explanation
In cases resistant to other treatment, manipulation-under-anesthesia (MUA)

may be indicated. In MUA, the patient is sedated to reduce the level of pain
and muscle resistance. The orthopedic surgeon manipulates the shoulder to
break free the adhesions. An intensive regime of physical therapy is required
for a couple weeks following MUA to prevent new adhesions from forming
following the manipulation.
Shoulder Manipulation Under Anesthesia Contraindications for MUA include:
Insulin dependent diabetics
Those at greater risk for fracture such as the elderly or those with
osteoporosis.
Those with bleeding disorders
Patients with risks to anesthesia
Differential Diagnosis
Frozen shoulder is not the only condition that causes limited shoulder motion. This
list represents other causes of reduced shoulder motion:
Rotator Cuff Tear characterized by sudden shoulder pain after a traumatic

event such as a fall or heavy lifting.
Labrum Tear - pain that is accompanied by clicking and locking of the
shoulder.
Malignant Tumor - pain that is typically unremitting and worse at night. An
immobile, non-tender nodule or lump may or may not be palpable.
Impingement Syndrome - pain with overhead arm motion, often with history
of increased activity in the overhead position due to occupation or sports.
Fracture arm, rib, or shoulder fracture will limit shoulder motion. Fractures
are usually associated with trauma.
Dislocation of the shoulder- a dislocation of the shoulder is normally a
traumatic event that is easily recalled by the patient.
Thank You

Frozen...

Uploaded by

Copyright:

Available Formats

Frozen...

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Frozen...

Uploaded by

Copyright:

Available Formats

Journal Pain Management in

Tabel 1: condition that can lead to secondary frozen shoulder

MRI helpful in identifying other causes of stiff shoulder, such

Laboratory helpful in patients with lead to secondary frozen

Manual manipulation of the affected shoulder should be performed

The patient can expect the practitioner (typically a chiropractor or

In cases resistant to other treatment, manipulation-under-anesthesia (MUA)

Rotator Cuff Tear characterized by sudden shoulder pain after a traumatic

You might also like