Frozen Shoulder

Nama :
Andi Erdiankuneng K. C111 11 370
Iva Pinasti D. C111 11 366

Pembimbing :
Dr. Husnul Mubarak, SpKFR
Data Based Identity (24 Februari 2016)

• Name : Ny. Siti Hasnani

• Sex : Woman
• Age : 57 tahun
• Occupation : housewife
• Religion : moeslim
• Ethnic : Bugis
ANAMNESIS
Chief Complaint : Pain at left shoulder

History of present illness

• Pain at left shoulder since 2 months ago, sharp pain and
radiating until upper left shoulder. Pain when she try to
moving her left shoulder. patient feel difficult to move her left
shoulder. VAS 5/10.
• History of trauma (-) patient have a habit of sleeping with left
position. Patient always carrying her grandchild using her left
hand. She already got therapy for 6 times at Tadjuddin Chalid
Hospital.
• Patient working as a housewife and always doing a daily
activity like wash the dishes. Patient also tell us if she always
carrying her grandchild for a long time.
History of past illness
• DM : (-)
• HT : (-)
• History of gout arthritis (+)
Physical examination

General status
• Compos Mentis, Independent ambulation, Gait : Normal,
Postur : Normal, Right handed
• BP : 100/80 mmHg, HR :82 x/mnt, RR : 20 x/mnt, S: 36,5 C
• Head & Neck : Normal
• Thorax : Cor : Normal
• Pulmo : Normal
• Abdomen : Liver/Spleen : Impalpable
• Extremitas : Upper Extremity :
• Inspection : Normal
• Palpation : pain in left shoulder
Lower Extremity : Normal
 Musculoskeletal Examination
Shoulder

Flexion Full(0-1800)/limited (0-1000) 5/5

Extension Full (0-600)/limited (0-500) 5/5

Abduction Full (0-1800)/limited (0-1200) 5/5

Adduction Full (0-450)/full (0-450) 5/5

Ext. Rotation Full (0-700)/limited (0-500) 5/5

Int. Rotation Full (0-900)/full (0-900) 5/5

Neurological Examination

• DTRS : BPR +/+ KPR +/+

TPR +/+ APR +/+
Local Status Regio Shoulder
• Inspection : deformitas (-), udem (-), atrofi (-)
• Palpation : pain in shoulder muscles
Special examination

• Drop hand test (-)

• Empty cane test
• Diagnosis : frozen shoulder
Functional Examination :

• Impairment : pain at left shoulder

Limited ROM
Adhesive capsulitis
• Disability : limiting on self care (daily life activity)
• Handicap : Difficult to doing her activity as a
houswife
Problem list
• adhesive capsulitis
Planning of Medical Rehabilitation

• Therapy plan :
Exercise : ROM – Streching, finger ladder exercise, towel
exercise, pendulum shoulder exercise,
overhead pulley, shoulder wheel
Modality : - USD rotator cuff
- TENS (Transcutaneous Electrical Nerve
Stimulation)
• Education plan : don’t carry any heavy thing. Change
sleep position. Do exercise at home
Prognosis
• et vitam = bonam
• Sanationam = bonam
• Et fungsionam = bonam
Case Review
• a woman aged 57 years came with complaints of pain in the
left shoulder since the month of February 2016. The patient
began treatment to rehabilitation medic in March 2016 .
Today, patient has got 6 therapies. Patients admitted difficulty
moving his left arm and it is very painful when moved. Pain in
the left shoulder felt spread quickly to the upper arm. Patients
no history of DM, no HT, arthritis gout (+) but controlled. On
physical examination after receiving 6 times the therapy, ROM
in the shoulder get limited but there have been improvements
in flexi and abduction but not full yet. There are no signs of
inflammation or crackles. On the arm drop test in getting a
negative result. Muscle spasms in the shoulder were also
obtained.
FROZEN SHOULDER
DEFINITION
• Frozen shoulder, also called adhesive capsulitis, causes pain
and stiffness in the shoulder. Overtime, the shoulder becomes
very hard to move.
• In frozen shoulder, the shoulder capsule thickens and becomes
thigt.
Etiology and Pathophysiology

The causes of frozen shoulder are not fully understood. There is

no clear connection to arm dominance or occupation. A few
factors may put you more at risk for developing frozen shoulder.
• Diabetes
• Other disease (hyperthyroidism, hypothyroidism, parkinson’s
disease, cardiac disease)
• Immobilization
Classification

• Freezing : in the freezing stage, you slowly have more and

more pain. As the pain getting worse, your shoulder loses the
ROM. Freezing typically lasts from 6 weeks to 9 months.
• Frozen : painful symptom may actually improve during this
stage, but stiffness remains. During the 4-6 months of the
frozen stage, daily activity may be very difficult.
• Thawing : shoulder motion slowly improves during the
thawing stage. Complete return to normal or close to normal
strength of motion
Clinical Manifestation

• -shoulder pain when moved

• - limited ROM
Supportive examination

• Physical Examination
• ROM : active ROM or passive ROM
• Drop arm test to see there is some tear in rotator cuff tendon or
not.
• Empty cane test

• Radiology Examination
• 1. MRI
• 2. USG
Planning
• Exercise
• USD
• TENS
• Farmakologi : corticosteroid injection
• Surgery : manipulation under anesthesia, shoulder
arthroscopy