Frozen Shoulder: Diagnosis and Physical Therapy Management

Abstract

Background: Frozen shoulder (FS), also referred to as primary idiopathic stiff shoulder, is a condition that causes significant morbidity due to pain and restricted range of motion (ROM). Despite its prevalence, the precise etiology remains unclear. While FS was previously considered self-limiting, recent evidence suggests chronic morbidity in 20-50% of cases.

Aim: To explore the epidemiology, diagnostic criteria, and therapeutic approaches for FS, focusing on physical therapy as a primary management strategy.

Methods: This review synthesizes current literature on FS diagnosis and management. It highlights diagnostic imaging methods, including plain radiography, ultrasound, and MRI, and evaluates the efficacy of various physical therapy interventions. These interventions include stretching exercises, cryotherapy, Mulligan technique, and adjunct therapies like suprascapular nerve blocks.

Results: Epidemiological data show FS affects approximately 4% of the population, predominantly women over 40. Diabetes mellitus and thyroid disorders are significant risk factors. Physical therapy remains a cornerstone of management, with techniques like posterior stretching, extracorporeal shock wave therapy, and cryotherapy demonstrating improvements in pain relief, ROM, and functionality. However, evidence supporting long-term benefits is limited due to small sample sizes and short study durations.

Conclusion: Frozen shoulder significantly impacts quality of life, with limited effective interventions altering its natural history. Early diagnosis, coupled with evidence-based physical therapy techniques, offers the best potential for improving outcomes. However, further research is needed to validate these approaches and identify optimal treatment protocols.