Definition

Frozen shoulder is a condition characterized by pain and progressive restriction of both active andpassive shoulder joint movements due to inflammation, fibrosis, and tightening of the joint capsule.

Stages

1. Freezing Stage (Painful Stage): Gradual onset of pain with increasing stiffness. Duration: 2–9months.

2. Frozen Stage (Stiff Stage): Pain reduces but stiffness remains significant. Duration: 4–12months.

3. Thawing Stage (Recovery Stage): Gradual return of range of motion. Duration: 6–24 months.

Causes

- Idiopathic (unknown cause)

- Post immobilization

- Trauma or injury

- Post-surgical conditions

- Systemic diseases

Risk Factors

- Age (40–60 years)

- Diabetes mellitus

- Thyroid disorders

- Prolonged immobilization

- Female gender

- Previous shoulder injury

Signs and Symptoms

- Shoulder pain (especially at night)

- Progressive stiffness

- Limited active and passive ROM

- Difficulty in daily activities (combing hair, dressing)

- Muscle weakness (secondary)

Treatment

- Pain management (NSAIDs, heat therapy)

- Corticosteroid injections

- Physiotherapy- Joint mobilization

- In severe cases: Manipulation under anesthesia or surgery

Physiotherapy Protocol

Goals:

- Reduce pain

- Improve ROM

- Restore function

Techniques:

- Passive and active-assisted exercises

- Stretching

- Strengthening exercises

- Electrotherapy (IFT, TENS, Ultrasound)

Mobilization According to ROM Restriction

Grade I–II (Painful Stage):

- Gentle oscillatory mobilizations

- Pain relief focus

Grade III–IV (Stiff Stage):

- Sustained stretches- Increase capsular extensibility

Directional Mobilization:

- External Rotation restriction → Anterior glide

- Internal Rotation restriction → Posterior glide

- Abduction restriction → Inferior glide- Internal Rotation restriction → Posterior glide