Frozen Shoulder

Physical therapy CRITICAL (most important intervention): pendulum exercises (lean over, let arm hang, gentle circles—uses gravity, minimal pain), passive range of motion (use other arm or therapist to move affected arm—essential to prevent permanent stiffness), wall walks (fingers walk up wall—gradually increases ROM), pulley exercises, stretching (hold gentle stretch at end ROM for 30 seconds, repeat—consistency more important than intensity), perform exercises 3-5x/day minimum (frequent gentle stretching better than infrequent aggressive stretching), Pain management: ice after exercises (reduces inflammation), heat before exercises (increases tissue extensibility), NSAIDs short-term (allow participation in PT), Pain control critical (severe pain prevents effective PT—physical therapy must be done despite pain but shouldn't cause severe pain—'hurt but not harm' principle), corticosteroid injection into joint (reduces inflammation, improves ROM, allows better PT participation—consider if pain limiting therapy, 1-3 injections maximum), Avoid: complete immobilization (worsens stiffness—'use it or lose it'), aggressive manipulation outside medical setting (can cause further damage—if manipulation done, must be under anesthesia by orthopedic surgeon), overhead activities that cause severe pain (but gentle stretching to end ROM essential), Sleeping: support arm with pillow (reduces pain at night), Sleep position that doesn't worsen pain, Continue exercises even after pain improves (prevent recurrence, restore full ROM—takes 18-36 months typically), Optimize underlying conditions: strict diabetes control if diabetic (HbA1c <6.5%), treat thyroid dysfunction, reduce systemic inflammation, Patience required (frozen shoulder has three phases: freezing—increasing pain and stiffness, 3-9 months; frozen—severe stiffness, less pain, 4-12 months; thawing—gradual improvement, 12-24 months; total duration typically 18-36 months), Manipulation under anesthesia (MUA): for severe, refractory cases after 12-18 months conservative treatment—done by orthopedic surgeon under anesthesia, forcefully moves arm to break adhesions, followed by immediate aggressive PT, risks (fracture, rotator cuff tear, joint damage—rare), 70-90% good outcomes, Arthroscopic capsular release: surgical alternative to MUA—arthroscope inserted, capsule cut to release contracture, less force than MUA so potentially lower fracture risk, followed by aggressive PT, 80-90% good outcomes.