Case of the Week 12-26-11: Eclectic Management of Frozen Shoulder

I am treating a patient who is married to a PT, yet she chose to refer her husband to me as a result of him having an extremely restricted left shoulder and moderately restricted right shoulder in all planes.

Quick history: Had pacemaker implanted 6 months ago, since then noticed progressively worsening left shoulder flexibilty. In the last 2 months, his wife also noticed decreased right shoulder mobility. Left shoulder flexion was 45/hard end feel, IR 10/hard, ER 0/hard, abd 55/hard. Right shoulder flexion 90/hard, IR 35/hard, ER 65/hard, abd 90/hard. All motions more painful at end range on left > right. These were all PROM.

Five visits later, he has left 160 abduction, 45 ER, 55 IR, right is almost WNL for elevation, IR and ER and has nearly no pain with ADLs.

This is his treatment program

IASTM to:

upper traps, levator scapula
cervical and thoracic paraspinals to inferior scapula
lateral upper arm
subscapularis

Functional Release to:

subscapularis
pec minor and major

Mobilization with Movement

inferior glide/arm slide
upper thoracic spine
scapula
first rib

Thrust Manipulation

upper and mid thoracic - made the BIGGEST difference in regard to left UE elevation, as I test and re-tested after each technique and while there were marginal improvements after each, on the 2nd visit went from 55 scaption to 95 after two thrust techniques

HEP

pt holds scapula with opposite hand, observes for improper firing of upper traps, sets his scapula then moves into only pain free range of scaption several times/hour
self distraction several times/day
thoracic rotation in sidelying "open book"

The HEP is surprisingly simple and works on several levels. He is working in the pain free range which decreases anxiety about movement; it demonstrates movement does not have to be painful and decreases CNS sensitivity. It also keeps remodelled tissues and capsule moving in the new range after plastic deformation. The light inflammation that is caused by IASTM causes healing and the repeated motions cause remodelling in the new range.