Frozen Shoulder - Test for Massage Therapist

What is the Frozen shoulder?
- It is a adhesive capsulitis
- Inflammation of shoulder joint capsule —> Scarring develop (Adhesion) —–> shoulder movement becomes restricted and moving the joint become painful

Causes
- Primary : Inflammation of the tissue surrounding the joint ( inflammation of muscles and/or tendons, as with rotator cuff tendinitis or bursitis) —> but it does not know the reason of the inflammation
- Secondary
  - Instrinsic musculoskeletal trauma : Rotator cuff tears, impingement syndrome, bursitis, osteoarthritis, gout, inflammatory synovitis
  - Trigger points in subscapularis
  - Disuse following shoulder injury or immobilization
  - Postural dysfunction : Hyperkyphosis, protacted scapulae and head-forward posture
  - Systemic disease : Diabets, hyperthyroidism

Two goals of the treatment
- To increase motion
  - Physical therapy
- To decrease pain
  - Anti inflammatory medication
- —–> If the two treatments do not effected,, surgery recommended.

SOPA
1. Symptoms
  1. Acute stage ; Freezing phase, painful phase
    - Gradual onset of pain, perhaps after a minor trauma such as twistin the shoulder
    - Client can not move.
    - Pain is severe at night and client is unable to lie on the affected side
    - This stage lasts for two to nine months and longer if aggressive therapy is used
  2. Subacute ; frozen phase, stiffening phase
    - severe pain begins to diminish
    - Stiffness becomes the primary complaint
    - Restriction in the capsular pattern : abduction, ecternal rotation and internal rotation
    - There is pain at end ranges of motion. Limitation of pain
    - This stage last four to 12 months
  3. Chronic : Thawing phase, resolution phase
    - Pain is localized to the lateral arm and continues to diminish.
    - Motion and function gradually return. however, full range of motion is not always regained.
    - It canbe resolve spontaneously in two years, or remain 10 years
2. Objective information
  1. Observations
    - Gait cycle : the affected arm is hel stiffly
    - Posture : maybe hyperkyphosis
    - The affected shoulder is elevated and protracted
  2. Palpation
    - Hypertonicity and trigger points : upper trapezius, levator scapula, shoulder girdle muscles
  3. Testing
    1. ROM
      1. Acute / Subacute
        
        AF / PR ROM : Restricted by pain in abduction, external rotation and internal rotation
        
        AR ROM : There may be no pain with resisted movement or pain if there is an associated tendinities
      2. Chronic
        
        AF / PR ROM : begin to return to normal
        
        AR ROM : may reduced strength of the shoulder girdle muscle(specially abduction and lateral rotation muscles)
    2. Special test
      1. Apley’s scratch test
      2. Painful arc test
      3. Adhesive capsulitis abduction test, PR
3. Treatment
  1. Acute
    1. Apply ice pack to the affected shoulder, compensating structures apply hot pack.
    2. Trigger point : subscapularis, Pectoralis, Subcalvius, Deltoid
    3. Fascial techniques : around shoulder, pectoralis
    4. Lymphatic drainage techniques : affected shoulder
    5. Avoid joint play
    6. PNF or passive stretch : subscapularis, upper trapezius and levator scapula
  2. Subacute
    1. Apply hot pack
    2. Friction : shoulder girdle muscles and tendons. ex)biceps tendon, infraspinatus and subscapularis
    3. Trigger points : subscapularis, Pectoralis, Subcalvius, Deltoid
    4. Fascial work : pectoralis
    5. Joint play : Inferior gliding, Anterior gliding
  3. Chronic
    1. Treatment for tight muscles : Adductors of GH joint, Internal rotators of GH joint
      1. apply hot pack
      2. trigger point, fascial work, deep petrissage
      3. passive stretching
    2. Treatment for weak muscles : Abductors of GH joint, External rotators of GH joint
      1. apply ice pack
      2. stimulation techniques, ex) tapotement
      3. strengthening
    3. Joint play : Inferior gliding, Anterior gliding, Posterior gliding
4. Self – care
  1. Acute / Subacute
    1. Daily activities
      1. Sleeping in a sidelying position with the involved arm uppermost.
      2. Pillows are placed under the involved elbow
      3. Forearm to prevent internal rotation
  2. All stages
    1. Remedial exercise
      1. Passive pendulum(Codman) exercise in pain free range
      2. Wand exercise
      3. Wall-walking exercise
      4. Isometric exerciser for the muscles of the shoulder girdle
      5. Passively stretch the joint capsule by gravity
      6. Strengthening for weak muscles, stretch for tight muscles
      7. Image for remedial exercise : 955e9af43204b9463f91f955b9fb603d.jpg (720×656) (pinimg.com)

Treatment summary

	symptoms/signs	Massage tx
Acute (Freezing, painful)	– Client can not move. – Pain is severe at night and client is unable to lie on the affected side – This stage lasts for two to nine months and longer	– Apply ice pack to the affected shoulder – Trigger point on subscapularis – Fascial technique around shoulder – MLD – Avoid joint play
Subacute (frozen, stiffness)	– severe pain begins to diminish – Stiffness Restriction in the capsular pattern : abduction, external rotation – This stage last four to 12 months	– Apply hot pack – Friction on shoulder girdle muscles and tendon – Trigger point – Fascial techniques – Joint play
Chronic (Thawing, resolution)	– Pain is localized to the lateral arm and continues to diminish. – Motion and function gradually return. however, full range of motion is not always regained. – It can be resolve spontaneously in two years, or remain 10 years	– For tight muscles (adductors, I/Rotators) : Apply hot pack, Trigger point/ fascia / friction, Passive stretching – For weak muscles(abductos, E/Rotators) : Ice pack, Stimulation technique ( tapotement), strengthening, Joint play

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