Figure 4: External Rotation
Figure 5: Internal Rotation
Evidence-based practice: Early applications of stretching and joint mobilization in the frozen phase should concentrate on improving elevation mobility first, which is produced with inferior glides. Using inferior glides will also allow for improvement to adjacent capsular restrictions and benefit mobility of external rotation and abduction. This treatment plan is confirmed by the Rundquist and Ludewig (2004) seminal study.
Case study Idiopathic Adhesive Capsulitis - Left Shoulder Dysfunction This case demonstrates the process of range of motion acquisition and exemplifies an optimal level of sustained weekly ROM improvement. Figure 6 shows the patient’s active external rotation at neutral on the discharge date. All active ROM measurements were taken prior to treatment, directly from the chart (Figure 7). Figure 6
Figure 7 Flexion Abduction External Rotation
October 15th
54°
46°
14°
November 1st
101°
74°
24°
November 15th
104°
76°
35°
December 1st
110°
78°
48°
December 15th
121°
84°
52°
December 30th
124°
88°
54°
Average Change/Week
8.75°
5.25°
5°
A 66-year-old, right-handed dominant patient presents with left frozen shoulder syndrome. The patient reported insidious onset of left shoulder pain, increased stiffness and loss of functional mobility for several months. The patient denied prior injury or no relevant medical history. She did not receive any injections or pharmacological treatment to the shoulder. This patient was treated with combined joint mobilization using proximal control and in-clinic manual stretches. She was also provided a home exercise program that emphasized daily external rotation static self-stretches. The patient adhered to the home exercise program and clinic attendance. The patient’s progress indicates an optimal, steady improvement in active ROM (Figure 7). The listed mobility changes correlate with the early emphasis on elevation (with inferior glides) and after two weeks an increased emphasis on stretches for external rotation. At year’s end, the patient was discharged due to lapse of insurance coverage. Although she had remnant external rotation deficits as cited in prior discussion, she was pleased with her functional capacity and minimal pain.
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