Frozen Shoulder

Karmi A. corpus
Vanessa S. Butac
BSPT-4
Anatomy
• Shoulder-a complex of 20 muscles and 3 bony articulations
-has the greatest mobility of any joint in the body
-depends mainlyb on the ligaments and muscles for its stability
Bony articulations:
1. Sternoclavicular joint-only attachment to the trunk
2. Acromioclavicular
3. Glenohumeral
Anatomy
• Functional joints:
1. Scapulothoracic
2. Suprahumeral/subacromial
3. Costosternal
4. costovertebral
Etiology
• Idiopathic or primary
• Direct/indirect trauma to shoulder
• CVA
• Reffered pain from cardiac or nerve root affection. this is due to the
common link of the heart and shoulder especially the left(embryonic
origin)
Muscles
• FLEXION: Anterior fibers of deltoid, pectoralis major
• EXTENSION: posterior fibers of deltoid, latissimus dorsi
• ABDUCTION: Middle fibers of deltoid, supraspinatus
• ADDUCTION: Pectoralis major, latissimus dorsi
• LATERAL/EXTERNAL ROTATORS: infraspinatus, teres minor
• MEDIAL/INTERNAL ROTATORS: subscapularis, latissimus dorsi
• Inflammatory process such as:
a.Supraspinatus tendinitis
b. Subacromial burtisitis
c. Tenosynovitis of long head of biceps
d. Acromioclavicular arthritis
e. Impingement syndrome
f. RSD
Etiology
• F>M between 40-60 year old
• Left shoulder>right shoulder
• The volume of fluid accepted by a normal shoulder varies from 20-
35ml
• Joint capsule is friable
Open packed position:
55-70 degrees abduction, 30 degrees horizontal adduction and neutral
rotation

closed- packed position:

Maximum abduction and external rotation
Stages
I. Freezing
II. Frozen
III. Thawing
Diagnosis
• ARTHROGRAPHY
• Can either be done fluoroscopically or with help of MRI
• 50 % reduction in joint fluid volume and box like appearance of the
joint cavity is diagnostic
• Joint volume capacity is only 5 to 10 ml (normal = 20 to 30 ml)
• Tight thickened capsule,loss of the axillary recess, subcoracoid folds
and subscapular bursa and absence of dye in the biceps tendon
sheath.
Diagnosis
• MRI
• The normal inferior glenohumeral ligament measures <4mm and is
best seen on coronal oblique images at the mid glenoid level. In
adhesive capsulitis, the axillary recess may show thickening up to 1.3
cm or more; the joint capsule is also thickened
• Classical “ subcoracoid triangle sign is seen” in sagittal oblique T1
weighted images
Management
• HMP
• Exercise
a. codman’s exercise
b. Sperry’s excercise
c. Shandler’s excercise
d. Overhead pulley
e. Finger ladder
f. Shoulder wheel
Management
• Ultrasound
• Joint mobilization