This rehabilitation protocol has been developed for the patient with adhesive capsulitis, or “frozen shoulder.” Shoulder stiffness may be caused by a variety of factors. In many cases, frozen shoulder due to adhesive capsulitis will get better over time with no specific treatment, but this recovery may take over a year, and the shoulder may never regain its original range of motion. Frozen shoulder due to other causes (such as trauma) may not get better without treatment. Initial treatment for this problem may include cortisone injection and/or oral anti-inflammatory medications for comfort, but physical therapy is the key to help facilitate recovery. In some cases, maximal improvement cannot be achieved without surgery. Physical therapy is also very important after a surgical procedure for frozen shoulder to ensure that the range of motion achieved at surgery is maintained.

This protocol will vary depending on factors such as:

• The cause of the frozen shoulder
• Whether a surgical procedure has been performed
• Strength/pain/swelling/range of motion status
• Rehabilitation goals and expectations

Passive range of motion is the key to recovery. If surgery has not been
performed, it is important that range of motion gains are seen over time. The
progress that is made must be monitored periodically by the therapist and your
doctor. If no progress is made over a 3-month period of regularly attended
physical therapy, a manipulation under anesthesia or surgery may be needed,
although this is uncommon. If manipulation or surgery has been performed, it is
important that the motion gained at the time of the procedure is maintained.

This protocol is divided into phases. Each phase is adaptable based on the
individual and special circumstances.

The overall goals of the surgical procedure and rehabilitation are to:

• Regain normal shoulder range of motion
• Control pain
• Regain normal upper extremity strength and endurance
• Achieve the level of function based on the orthopedic and patient goals

A CPM machine may be used for home range of motion. The supervised
rehabilitation program is to be supplemented by a home exercise and stretching
program.

If surgery is performed, important post-op signs to monitor:

• Swelling of the shoulder and surrounding soft tissue
• Abnormal pain response, hypersensitive-an increase in night pain
• Severe range of motion limitations
• Weakness in the upper extremity musculature

Return to Activity

Return to activity requires both time and clinical evaluation. To safely and
most efficiently return to normal or high level functional activity, the patient
requires adequate range of motion, strength, flexibility, and endurance.
Symptoms such as pain, stiffness, swelling, or instability should be closely
monitored by the patient.